LIBRARY OF CONGRESS, 



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united states of america. 




V- 



A TEXT-BOOK 



OF 



Practical Therapeutics, 



WITH ESPECIAL REFERENCE TO THE 



APPLICATION OF REMEDIAL MEASURES TO DISEASE 



AND THEIR 



EMPLOYMENT UPON A RATIONAL BASIS. 



BY 



/ 



HOBART AMORY HARE, M.D., B.Sc., 

PROFESSOR OF THERAPEUTICS AND MATERIA MEDICA IN THE JEFFERSON MEDICAL COLLEGE OF 

PHILADELPHIA ; PHYSICIAN TO ST. AGNES'S HOSPITAL AND TO THE JEFFERSON MEDICAL 

COLLEGE HOSPITAL ; CONSULTING PHYSICIAN TO THE FRANKLIN REFORMATORY 

HOME ; LAUREATE OF THE ROYAL ACADEMY OF MEDICINE IN BELGIUM, 

OF THE MEDICAL SOCIETY OF LONDON, ETC. J PRESIDENT OF THE 

SECTION OF THERAPEUTICS IN THE PAN-AMERICAN 

MEDICAL CONGRESS. 



THIRD EDITION, ENLARGED AND THOROUGHLY REVISED. 







WASJJJg 



PH ILADELPHIA: 

LEA BROTHERS & CO 

1892. 



9- 



# 



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Entered according to the Act of Congress, in the year 1892, by 

LEA BROTHERS & CO., 
in the office of the Librarian of Congress. All rights reserved. 



DORNAN, PRINTER. 



THIS VOLUME 
IS DEDICATED TO 

Dr. J. WILLIAM WHITE, 

PROFESSOR OF CLINICAL SURGERY IN THE UNIVERSITY OF PENNSYLVANIA, 

AS AN 
EVIDENCE OF FRIENDSHIP AND ESTEEM, 



THE AUTHOR 



PREFACE TO THE THIRD EDITION 



In presenting the third edition of this Text-book of Practical 
Therapeutics to the profession the author may be allowed to ex- 
press his gratification at the favorable reception accorded its prede- 
cessors. Just two years 'ago the book made its first appearance, and 
the rapid exhaustion of the editions has forced the author to be 
constantly engaged in revising the work and preparing it for the 
publisher. By this constant attention to the smallest detail connected 
with the book the author has been able to present not only accurate 
information, but also the very latest reliable results obtained in the 
treatment of disease by those who have employed the newer remedies. 
In this edition directions are given for the use of drugs of such 
recent introduction as Salophen, Guaiacol, Diuretin, Europhen, Thiol, 
Phenocoll hydrochloride, Piperazine, Dermatol, Pental, Terpine 
hydrate, Terpinol, and the salts of Strontium. Much information 
has also been added to the articles on such drugs as Salol, Phenacetine, 
Menthol, and similar comparatively recent remedies. Another im- 
portant addition is a list of drugs arranged as far as possible accord- 
ing to their physiological action and a list of definitions of the 
terms used to designate classes of drugs. 

In making the necessary additions the author has been careful to 
preserve that conciseness of statement and facility for ready reference 
which has done so much toward rendering the previous editions 
useful to the active practitioner and student, whose needs consist 
in having at hand a work which will not confuse the reader by the 
statement of many different views, but gives that which experience 
has shown will prove most useful in practice. 

Philadelphia, 222 South Fifteenth Street. 



PREFACE TO THE SECOND EDITION. 



The fact that the first edition of this book was exhausted within 
six months of its publication, and adopted as a text-book in a number 
of medical schools during that time, has encouraged the author in 
his efforts to make the work more serviceable than before. A 
number of new drugs are discussed which have been tried with suf- 
ficiently good results to warrant their introduction into a text-book 
and work of reference, aud the latest information regarding the more 
familiar medicaments has been added. The method of employing 
the rest-cure, and the use of suspension in the treatment of loco- 
motor ataxia and allied affections are given, and a large number of 
new prescriptions have been inserted to illustrate still further the 
best means of applying remedies for the cure of disease. 

Philadelphia, 222 South Fifteenth Street. 
May, 1891. 



PREFACE TO THE FIRST EDITION 



The object of this book is to provide the physician or under- 
graduate student of medicine with a reliable guide in the study of 
Therapeutics, or the application of remedial measures for the cure of 
disease. It has been written because, in the belief of the author, 
most of the text-books on this subject treat of it as if the student 
were already a skilled physician or experimental pharmacologist. As 
a consequence, two classes of undergraduate readers exist. One finds 
that the mixture of science and empiricism is too difficult for him to 
fathom, and is hopelessly confused ; the other simply learns the reme- 
dies and doses by heart and gives drugs with little idea as to what 
they are to do. Further than this, the physician is often at a loss to 
decide when a remedy is indicated, even though his theoretical knowl- 
edge of the subject be very thorough. Thus, he is told that ammo- 
nium chloride is a remedy in bronchitis, but the exact stage at which 
it is to be employed is often not stated ; or he knows that digitalis 
does good in cases of cardiac disease, but fails to recognize the fact 
that it is only when compensation is lacking that the drug is needed. 
For this reason Part IV. has been written, not with the object of 
providing a rigid system for treating disease, but rather for the pur- 
pose of bringing together the best remedies, and of showing how and 
why they are given. 

Rational therapeutics at the present day does not consist in a 
knowledge of doses and the materia medica, but exists as a complex 
art in which knowledge and its proper application, based on common- 
sense principles, go hand-in-hand. The treatment of " symptoms as 
they arise " by the employment of remedies recommended by some 
eminent authority is a variety of empiricism whose existence has 
depended largely on the fact that many physicians of the past have 



Xll PREFACE TO THE FIRST EDITION. 

either been so ignorant as to be led where a writer willed, or so sloth- 
ful as to be willing to let others think for them. Scientific research 
has so largely opened up to everyone the possibility of using drugs 
with a distinct idea of the reason for their employment, that the 
writer has endeavored to bring together in a readable form the com- 
bined results of laboratory and bedside experience, thinking the time 
ripe for such a task. It is true that several other books give, in a 
more or less thorough manner, a resume of the physiological action 
of the drugs of which they treat, but in even the best of them only 
the most trained student of pharmacology can discover the close rela- 
tionships which exist between the results reached by the physiologist 
on the one hand and the clinician on the other. The two parts of the 
study are usually so divorced by the prolonged mental effort neces- 
sitated by the arrangement of the text, that the student either ignores 
the physiological action for the sections on therapeutics, or crams the 
former to pass an examination required by the teacher whose course 
he must follow. As a consequence, too many physicians regard 
pharmacology simply as a species of mental training, or believe it to 
be a waste of time and energy. No one can think that the writer of 
this book will ever deny the value of original research or bedside 
experience, but he does desire to weave science and practice into so 
close a network that the foundations of experience may be cemented 
by the mortar of exact knowledge. In some instances, however, 
science and practice seem to be absolutely opposed, and only future 
research can explain the apparent contradiction. 

Throughout this book, in every part where drugs or diseases are 
considered, the writer has arranged the titles in alphabetical order, 
according to their English names. This has been done because it is 
desired to afford the reader a ready-reference book to which he may 
turn at short notice for desired information, for at present the state 
of pharmacology is so unsettled that a true classification is impossible. 
Thus, morphine may be classed by one writer as a nervous sedative, 
by another as a sleep-producer, by a third as a bitter substance, and 
by a fourth as a respiratory depressant. Bromide of potassium can, 
with equal propriety, be called a spinal sedative or a cerebral sedative, 



PREFACE TO THE FIRST EDITION. Xlll 

or caffeine be classed as a cerebral stimulant, a circulatory stimulant, 
or a diuretic. 

In order to make the book more complete, the preparations of the 
British Pharmacopoeia have been introduced ; and with the same 
object in view, a dose-list of drugs, both official and unofficial, has 
been appended for ready reference. The subject of medical electricity 
has heretofore commonly found a place in most text-books on thera- 
peutics, but has been advisedly omitted in this instance, since elec- 
trical therapeutics has outgrown any work save one devoted to that 
subject alone. 

For many of the articles on treatment the author wishes to thank 
friends who have earned prominence in connection with their special- 
ties. Thus Dr. G. E. de Schweinitz has contributed the articles on 
the treatment of diseases of the eye ; Dr. Edward Martin those on 
the treatment of venereal diseases and on antisepsis ; Dr. Barton C. 
Hirst those on the treatment of diseases of the puerperal state ; and 
Dr. J. Howard Reeves, the articles on the treatment of diseases of the 
upper air-passages. All of these articles enhance the value of the 
book to so great an extent that the author feels sure they will be 
sought out and read with interest. 

In addition to the general index, a copious and explanatory index 
of diseases and remedies has been appended, which will prove sug- 
gestive and valuable to practitioners, and for which the author is 
indebted to his friend and student, Mr. J. G. Clark. 

Philadelphia, 222 Solth Fifteenth Street. 
September, 1890. 



C01S T TE^TS 



PART I. 



PAGES 

G-eneral Therapeutical Considerations 17-38 



PART II. 

Drugs 39-335 

PART III. 

Remedial Measures other than Drugs 337-371 

Foods for the Sick 372-378 

PART IV. 

Diseases 379-629 

Table of Doses and Remedies . 631-638 

Tables of Relative Weights and Measures in the Metric 

and Apothecaries' Systems 639, 640 

Index of Drugs and Remedial Measures .... 641-657 

Index of Diseases and Remedies 659-698 



PART I. 

GENERAL THERAPEUTICAL CONSIDERATIONS. 



Before entering into a study of the action of drugs upon a living 
body, it is necessary that the student should possess a clear idea of 
what the word " therapeutics " means, the reason why we resort to 
drugs, and more important than all, that he should grasp the limi- 
tations which govern the administration of remedies. 

Two very foolish and unfounded ideas have recently been put 
forward by certain physicians — one being, that medical therapeutics 
is useless; and the other, that this branch of medical knowledge is not 
advancing with so great a stride as is pathology or surgery. The 
individuals who laugh at the general use of drugs in disease belong to 
one of two classes : either they have never tried them, or if so have 
used the drugs ignorantly or wrongly, or else they believe that they 
are promulgating a new theory, and do not know that the eras of ex- 
cessive dosage and of nihilism are alike relics of the past. No reform 
has ever attacked a crying evil without becoming excessive and absurd 
itself, and if successful in accomplishing its object has generally re- 
sulted not in the mere remedy of the faults it antagonized, but in so 
complete a reversal of popular opinion as to force its converts into 
ways as reprehensible as their former habits. Thus, in exactly the 
same manner that the excesses of Catholicism resulted in fanatical 
Puritanism, so did the careless methods of physicians during the past 
century lay the foundation for the growth of homoeopathy or thera- 
peutic nihilism. At the present time, although we have much to 
learn, it can be said that we have benefited by both of these errors, 
and are in consequence taking a path which may be considered the 
happy medium. 

To the majority of the readers of this book, however, the harm ful- 
ness of over-dosing is sufficiently evident, and the cry of " no drugs 
at all " so absurd that no rebuttal need be offered. 

The statement that therapeutics is to-day more backward than are 
pathology and surgery is readily answered by a denial ; for the thera- 
peutist is able to treat successfully many diseases of which the 
pathologist knows nothing, and is obliged to rest his treatment on 
empiricism simply because he cannot tell how his drugs act if the 
pathologist cannot tell him what the disease is. Rheumatism is a 
good example of this very point. 

2 



18 GENERAL THERAPEUTICAL CONSIDERATIONS. 

In regard to surgery, everyone must recognize the extraordinary 
advances made in this branch of medical science, yet comparatively 
few realize that it is solely by the introduction of drugs that all its 
triumphs are possible. The definition of the word " therapeutics" in 
Billings's Dictionary is : " that branch of medical science which treats 
of the application of remedies to the cure or alleviation of disease," and, 
practically, the term is almost universally used to signify the employ- 
ment of drugs for such purposes. The credit for the introduction of 
new instruments may or may not be accorded to surgery, but the dis- 
covery of new drugs must be accorded to therapeutics. We find, then, 
that ether and chloroform began to revolutionize surgery fifty years 
ago, and that corrosive sublimate, carbolic acid, and other drugs have 
revolutionized it once more within the lifetime of everyone who reads 
this book. Cocaine has changed the entire aspect of eye surgery and 
other minor operations, and has immediately averted an enormous 
amount of pain and suffering which the surgeon could not relieve, 
and certainly could not remove, in the absence of its influence. To 
the accusation of backwardness, the therapeutist can well reply by 
asking the champion of any other branch of medical science to put 
forward one discovery which equals antipyrine or acetanilide in 
power to relieve disease or pain, or which can be applied as specifics 
to so wide a scope of ailments. 

In the language of one of the most progressive medical men of to- 
day in the United States, the man who does not believe in the proper 
use of drugs for the cure of disease must lack the very keystone of the 
arch upon which all medical knowledge rests. 

The ultimate aim and object of all medical thought and effort is the 
cure or alleviation of disease, and therapeutics is the refined product 
culled from every department of medical learning. Like every other 
thing requiring a thorough knowledge of its component parts, it is 
often much abused by the careless and ignorant, but is a power for 
good in the trained hand of the properly educated physician. 

Further than this, therapeutics is the only universally used branch 
of medicine, for each and every branch must resort to it, and the most 
skilful operator who fails to treat his cases medicinally with equal skill 
will have worse results than he who, though bungling in his surgery, 
yet uses drugs intelligently after his slashing is finished. 

Homoeopathy depends upon more than one reason for its existence. 
If infinitesimal closes are given, the patient is satisfied that he is 
receiving medicine, and Nature often produces her most rapid cures 
w T hen left alone. Again, the entire basis of homoeopathic therapeutics 
rests not upon the study of the causes of diseases, but upon the symp- 
toms which constantly present themselves. As a result of this, so 
many minor symptoms are relieved that the patient's comfort is 
insured, and doubtless in many instances serious disorders are dis- 
covered which might otherwise be cast aside or go unseen. No detail 
should be too small to attract the attention of the physician, and he 
who exercises care in detail must reap reward in larger measure. 



MODES OF ADMINISTERING DRUGS. 19 



MODES OF ACTION OF DRUGS. 

Drugs act in two ways, which are sometimes called near and remote, 
direct and indirect. The near, or direct, action of a drug is that influ- 
ence which is felt by the exercise of its effects directly upon the tissues 
with which it comes in contact ; the indirect, or remote, influence is 
that result which comes as a sequence of its primary effect. As an 
illustration of this we may take the local use of cantharides. The 
local, near, or direct effect of this is a blister ; the remote or indirect 
effect is the absorption of exudations or the influencing of inflammatory 
processes. If pilocarpine is used, its direct effect is the sweating which 
ensues, while its indirect effect is the relief of dropsy through the 
removal of exudation by the increased action of the skin, salivary 
glands, and kidneys. 



MODES OF ADMINISTERING DRUGS. 

Drugs may be administered for the purpose of affecting the general 
system in many ways, but practically we employ only six methods, as 
follows : 

1. By the mouth or stomach. 

2. By hypodermic injection. 

3. By inhalation. 

4. By the rectum. 

5. By inunction. 

6. By the endermic method. 

By far the most usual manner of administering drugs is by way of 
the mouth, which is the most natural means of entrance into the body 
for foreign substances. Whenever medicines are used in this way, the 
physician should clearly bear in mind what the medicine is to do after 
it is swallowed. Thus, if the drug is intended to act directly upon the 
stomach it should not be given after meals, but some time before, since 
the food and gastric juice may afterward so cover the gastric mucous 
membrane that the medicament cannot act. Thus, in the case of 
chronic gastric catarrh or gastric ulcer the nitrate of silver which is 
used should always be given half an hour or an hour before meals. 
On the other hand, if an ulcer or other trouble exist in the small intes- 
tine, the pill should be given some time after meals, and if a heavy 
meal is taken, three or four hours after, since under these circumstances 
the medicine is swept out into the intestine almost at once, without 
remaining any time in the stomach, where it may be chemically altered. 
Very often it is necessary to give a medicine soon after food is taken, 
in order that it may not act in too powerful or concentrated a manner 
upon the viscus which receives it. 

The general rule, however, may be laid down, that all medicines are 
to be taken after rather than before meals, unless a local gastric effect 
or very rapid absorption is desired. 



20 GENERAL THERAPEUTICAL CONSIDERATIONS. 

Next to the use of drugs by the mouth, by far the most popular 
method is their admiuistration by means of the hypodermic needle and 
syringe. The logic of this method rests upon the absorption of all 
soluble substances from the subcutaneous tissues with great rapidity. 
Any substance soluble enough or suspendable enough to pass through 
a hypodermic needle without forming an obstruction may be employed, 
provided it is not too irritating and that it is " clean." 

The proper places to give such injections are the forearm, on the 
extensor surface, 1 the calf of the leg, the buttock, or the broad of the 
back — in other words, any spot where the tissues are not dense and 
unyielding. The skin of the part is to be grasped or pinched up with 
the thumb and forefinger of the left hand and the needle sent well into 
this raised fold, preferably above the finger and thumb — so that the 
pressure of the fingers may prevent pain and the too rapid entrance of 
the medicine into the system. The needle should always penetrate 
well into the loose connective tissue, so that the liquid injected may 
find lodgment in the loose and spongy subcutaneous tissues without 
separating the skin from its rather close adhesion to the tissues below 
or from the bloodvessels supplying it, for if suppuration occurs abscess 
and a slough may result. 

The dangers from hypodermic injections are chiefly two. First : 
The medicine may enter a vein, owing to the penetration of its wall 
by the needle, and the entire dose be carried at once, en masse, to the 
vital centres. Second : The solution used may not be sterile, or the 
needle may be dirty, and an abscess may result. The first danger is 
to be avoided by injecting into spots not well supplied with veins, and 
the second by thoroughly washing both syringe and needle with water 
the instant before they are used, pushing a fine wire through the needle, 
and in some cases by soaking the latter in carbolized oil. The liquid 
injected may be rendered sterile by using freshly boiled water and 
adding thereto carbolic acid in such proportion that one-half to one 
drop of carbolic acid is present in each injection. It is claimed by 
some that this use of carbolic acid seriously hinders absorption, and in 
cases of urgency it should not be used. Most hypodermic syringes 
hold from twenty to thirty minims. 

When drugs are given by the rectum, we employ them for three 
purposes. First, to influence the general system by their absorption ; 
secondly, to act locally upon any disease which may be present in this 
particular locality or in the colon ; and, finally, to dislodge substances 
or parasites which it is desired to bring away. The word " enema " is 
loosely used to denote all these injections, be their purpose what they 
may, and is synonymous with " rectal injection " or the more old- 
fashioned word " clyster." If nourishment is being given the injection 
is called a " nutrient enema." Sometimes these injections are called 
" lavements." 

1 Hypodermic injections into the anterior aspect of the forearm often cause much 
pain in the hand by irritating temporarily the branches of the radial or ulnar 
nerves. 



MODES OF ADMINISTERING DRUGS. 21 

In this mode of administration it is very necessary that the physi- 
cian should use his medicaments in proper bulk ; and it may be laid 
down as a rule that no more liquid should be injected than is necessary 
to convey the medicine or food, unless the injection is for the purpose 
of emptying the bowel of faecal matter or other materials, or it be 
desired to distend the bowel in order to overcome obstruction or to 
influence the colon by drugs. 

The reason for this lies in the fact that any large bulk of liquid sent 
into the rectum so stimulates its walls by distention as to cause spas- 
modic contraction, with expulsion of all the rectal contents, which is 
just what is needed when faecal matter is to be removed, but the 
opposite of what is desired when retention of a remedy or food is 
necessary for absorption or local action. In rectal catarrh or ulcer, 
two to four ounces of liquid are usually sufficient in an adult to accom- 
plish any medicinal influence locally or by absorption, while as a 
laxative enema one to two pints may be employed. 

In the use of injections we frequently find that the rectum becomes 
irritable, and promptly resists all efforts to force the entrance of liquids 
or solids. This is to be avoided by giving the injection so gently that 
the bowel fails to recognize, as it were, the entrance of liquid, and by 
introducing a few drops of oil and laudanum in each injection. 

A large amount of distress often follows the gradual accumulation 
of faecal masses in the colon which are not passed with the daily move- 
ment of the lower bowel. These can readily be removed by large 
injections of warm water or by the use of medicated liquids. 

A very important use of injections by the rectum is in the treatment 
of the various causes of intestinal obstruction. Here the greatest 
caution should be exercised that the injection be made with all 
possible gentleness, and slowly, the liquid being alloAved to dribble 
into the bowel rather than to force its way. It is dangerous to use a 
greater pressure than is given by a fountain syringe at the height of two 
or three feet, as rupture of the peritoneal coat of the bowel may occur. 
Where a large quantity of water is used it should be carefully warmed 
to 100° or a little more, and it is well to add salt to it, so that it will 
represent the normal saline strength of blood serum, namely, seven- 
tenths of one per cent. (For use of injections in special diseases see 
Part IV.) 

Suppositories are another means by which we introduce medicines 
into the bowel, either for local effect, or to act after absorption of their 
contents upon the general system. 

When drugs are given by inhalation they are generally employed 
with the object of affecting the respiratory tract alone, although there 
are notable exceptions to this in ether, chloroform, nitrous oxide gas, 
and other volatile substances. Aside from anaesthetics, we find such 
remedial measures adopted as the inhaling of steam laden with the 
drugs employed, the respiring of air loaded with the fumes of the 
medicament, or the inhalation of gases ; and last, and most commonly 
resorted to of all, the use of the atomizing spray, which, if properly 



22 GENERAL THERAPEUTICAL CONSIDERATIONS. 

made and employed, so minutely divides the liquid containing the medi- 
cine that the inspired air carries it to the furthest bronchiole and 
pulmonary vesicle. 

As examples of the rules governing the administration of drugs in 
this manner we find that compound tincture of benzoin may be taken 
by inhaling the steam arising from hot water containing it, but cannot 
be used in a spray because it occludes the fine points of the atomizing 
tubes. In a similar manner we may inhale the smoke of belladonna 
or tobacco leaves to relieve asthma, or the fumes of chloride of ammo- 
nium for bronchitis in its later stages. Finally, we find that oxygen 
is exceedingly useful, the gas being readily inhaled with good results 
in proper cases. 

The " spray " or atomizer is made in two forms ; one form of appa- 
ratus being worked through the agency of compressed air, the other 
through the escape of steam from a small boiler. Very few of the 
compressed-air atomizers throw a spray fine enough to reach the deeper 
parts of the lung, particularly if the air is compressed by the hand. 

The inhalation of moist air is very useful in bronchitis, and greatly 
aids other remedial measures. Steam may be disengaged in a room 
by means of a kettle of boiling water, or by placing pieces of unslaked 
lime in a pan of water. 

Inunctions consist in the rubbing into the skin of medicines gener- 
ally of an oily or fatty nature, or which assume this character through 
embodiment with oil or fat. The three substances most commonly 
used in this way are cod-liver oil, mercurial ointment, and iodine oint- 
ment. They should always be applied oil some part where the derm 
is thin and well supplied with subcutaneous lymphatics, as in the 
axillae, the groins, or the insides of the thighs. Other substances have 
been and may be used by inunction ; but as this method is necessarily 
a disagreeable and dirty one, it is rarely resorted to unless the stomach 
is disordered, or it is necessary to push the drug into the system by 
every possible avenue of entrance. 

The endermic method consists in the use of a blister by means of 
which the epiderm is raised, when a little morphine or other alkaloid 
may be slipped under it and so absorbed through the true skin. It is 
a painful method, almost never to be resorted to, which has been 
entirely supplanted by the hypodermic method of medication. 

Kennedies are administered in a number of forms, but chiefly as 
follows : 

Abstracts are dry powdered extracts mixed with sugar of milk 
until they are twice as strong as the crude drug ; only eleven of them 
are official. 

Aceta, or vinegars, are solutions of drugs in vinegar or acetic 
acid. There are four in the United States Pharmacopoeia and three 
in the British. 



MODES OF ADMINISTERING DRUGS. 23 

Alkaloids are organic bases, generally occurring in crystalline 
form and abstracted from crude drugs. They nearly always represent 
the active principle of the drug. 

Aquje, or waters, are used as vehicles either for the dilution of 
strong medicines, or for the purpose of carrying minute amounts of 
flavoring materials. 

Cataplasms are not official in the United States Pharmacopoeia, 
but are in the British Pharmacopoeia. They are virtually poultices 
made of linseed-meal or of bread-crumbs. 

Cerates are ointments containing wax to render them harder than 
would ordinary fats. 

Charts, or papers, consist of bibulous paper soaked in a solution 
of the drug which they are meant to carry. 

Confections are sometimes called electuaries or conserves, and are 
soft pastes which contaiu the drug mixed with sugar or honey. 

Decoctions are solutions of drugs made by boiling and then 
straining while hot. 

Elixirs are diluted tinctures rendered pleasant to the taste by the 
addition of aromatic substances and sugar. 

Emplastra, or plasters, are made up of adhesive substances 
placed upon a backing of cloth or leather and designed to adhere to 
the skin : being so applied for the purpose of holding a medicinal 
substance in contact with the body, of acting as a protective, or of 
aiding in the approximation of the edges of a wound. 

Extracts consist of the soluble parts of plants reduced to a 
semi-solid or solid condition by evaporation ; the soluble constituents 
being taken from the plant by water or alcohol. 

Fluid Extracts are made in the same way as solid extracts, 
except that they are not so completely evaporated. 

Glycerita, or glycerins, are solutions of various substances in 
glycerin — the glycerin being used as a vehicle. 

Infusions are made by pouring boiling water on the crude drug 
and allowing it to stand for a short time until the water cools, after 
which the liquid is strained. Sometimes cold water is employed. 

Pills are small round masses which, as a general rule, should not 
weigh more than three grains, in order to avoid their being too 
bulky. If the material is a heavy one, as much as five grains may 
be placed in each pill. Pills may be uncovered or coated with 
sugar or gelatin. If the pill is fresh and the sugar pure they are 
useful. Many pills are fraudulently coated with varnish and are 
insoluble. 

Suppositories are small masses made into a cone shape and 
having for their basis cacao butter. They are designed to carry into 
the rectum certain medicines for absorption into the system or for local 
action. 

Tablets. Under this name manufacturing pharmacists and others 
prepare small compressed pills or lozenges, generally of small size, the 
mass being made to adhere by means of its being subjected to great 
pressure by special machinery. Smaller tablets are used for carrying 



24 GENERAL THERAPEUTICAL CONSIDERATIONS. 

powerful drugs for hypodermic use. These, however, are often only 
lightly pressed so as to render them easily soluble. 

Tinctures are solutions of the active principles of drugs in 
alcohol. 

Triturates are made by adding ten per cent, of the active medi- 
cine to ninety per cent, of milk-sugar. These are then carefully 
rubbed together until the two are intimately mixed, and are very 
valuable in the administration of medicines to adults or to children. 

Troches, or lozenges, are flat, hardened masses designed for hold- 
ing medicines in the mouth so that they may be slowly dissolved, 
thereby affecting the local mucous membrane. 

Ointments, or unguents, consist of the mixture of some kind of 
fatty substance with the medicine which they are designed to carry. 

Wines are made in the same way as tinctures — strong white wine 
being used in the United States, and sherry or orange wine in Great 
Britain, in place of ordinary alcohol. 



DOSAGE. 

There is, unfortunately, no absolutely fixed rule which can be 
applied to dosage, for several reasons. In the first place, the indi- 
vidual may not be readily affected by drugs, or the disease-process 
which is present may so antagonize them as to render very large doses 
necessary. Further than this, the age and sex of a patieut have much 
to do with the regulation of the proper amount of a drug which we 
may give. Finally, that curious but common condition of suscep- 
tibility to various remedies, that we call idiosyncrasy, creeps in as an 
important factor in the decision as to the dose which should be given 
in each case. By far the nearest approach which we can make to 
absolute accuracy in dosage, is to use drugs according to the weight of 
the patient, but this method possesses the disadvantages that we cannot 
always weigh our patients, and that the presence of a large amount of 
fat or of dropsy will make an unknown quantity in our calculation as 
to the true weight of the active part of the individual. 

At present we are accustomed to be governed by a list of doses 
to be given to all adults within certain limitations, and which are 
varied sufficiently to permit of great differences in the effects obtained. 
It is in this very point that the success of many a physician chiefly 
rests ; for the use of a dose by " rule of thumb " is as empirical and 
lacking in thought as is use of a remedy, not because we have a defi- 
nite action for it to carry out, but because it did someone else good 
who was suffering from what appears to have been a similar attack. 
The dose must be varied to fit the case in the same manner that the 
cut of a coat must be varied to fit each individual. 

There are a number of approximate rules in regard to the doses 
which are to be given in treating the diseases of children, the best of 
which is Young's rule. This is as follows : 

Add 12 to the age and divide by the age. Thus, if a child is two 



IDIOSYNCRASY. 25 

years old, we have the following formula : 2 + 12=14-^-2 = 7; 
or, one-seventh of the dose for an adult is the dose for a child of two 
years. This rule is not a law, however, for of narcotics children 
receive less than this (one-half), and of purgatives or laxatives more 
than this (two to three times). 

When drugs are given hypodermically the dose should be generally 
one-half to one-quarter of that given by the mouth, and if any thought 
of idiosyncrasy exist the dose should be smaller still at the start if 
powerful remedies are to be used. 

By the rectum the dose should be twice the amount given by the 
mouth, unless the drug be very powerful or capable of very rapid 
absorption. 

IDIOSYNCRASY. 

This is one of the most interesting features of the study of the action 
of drugs. It is a frequent cause of disappointment to both patient and 
doctor, and an equally frequent cause of excessive action from what 
the physician has thought to be a moderate dose. No rule can be 
laid down for the discovery of idiosyncrasy in a given case, except that 
females, particularly of the hysterical type, are more subject to it than 
are males, although certain men often present marked evidences of 
this tendency. Xo better illustration of idiosyncrasy can be adduced 
than the case which here follows, nor than that of a friend of the 
author, who cannot eat a strawberry without suffering from a violent 
attack of hives. 

The first case is that of a woman of thirty years, suffering from 
severe headache, who received an eighth of a grain of the hydro- 
chlorate of pilocarpine, hypodermically, every twenty minutes, until 
nearly three-fourths of a grain was taken, without any evidence of its 
action either in salivary flow or sweat. But the tolerance of drugs 
did not stop here. Twenty drops of tincture of cannabis indica every 
four hours failing to relieve the pain, half-grain pills of the solid 
extract were ordered, two of which commonly affect a grown man 
most markedly. The extract had been proved to be active to other 
patients. In order to avoid any failure in absorption the pills were 
each cut in half before they were given, and forthwith administered, 
one every three hours, without any effect after ten had been taken. 
Twenty more of the pills, from the same manufacturers but from a 
different retailer, were now given, one every hour with the exception 
of a few irregularities in administration during the night, the entire 
twenty being swallowed between four o'clock one afternoon and tw r o 
o'clock in the next afternoon. The thirty pills (15 grains) were 
taken in less than forty-eight hours without producing a single physio- 
logical sign of the slightest character. That the doses were really 
sw r allowed would seem to be undoubted, for their administration was 
carried out by a trained attendant, and their black color forbade their 
expulsion from the mouth on the bed without attracting attention. 
The hypodermic injections were given by the author, and as the solu- 



26 GENERAL THERAPEUTICAL CONSIDERATIONS. 

tion was made as fast as it was used, the patient must certainly have 
received all of the pilocarpine. 

As there was daily an afternoon rise of temperature amounting to 
several degrees, quinine bisulphate was ordered in the dose of fifteen 
grains, to be given after six powders of one-sixth of a grain of calomel 
had been taken ; this not only failed to control the fever, but also 
produced no buzzing in the ears. The writer was now inclined to 
consider all the symptoms as hysterical, even including the evening 
rise of temperature. 

Twenty-four hours after the last dose of cannabis indica, the attendant 
gave the patient, without orders, no less than sixty grains of antipyrine 
in sixteen hours without any physiological symptoms, and, under orders, 
she took from forty to fifty grains of bisulphate of quinine every day 
for three days without any signs of cinchonism. 

Wide experience has taught us, however, that several conditions act 
fairly constantly in regard to some idiosyncrasies. Certain diseased 
conditions — such as peritonitis or pain — allow large doses of opium to 
be given, and in lead-poisoning and paralysis patients may require 
enormous doses of active purgatives to move the bowels. 

The climate in which the patient lives, or has been accustomed to 
live, renders hirn more or less susceptible to certain remedies. Thus 
the East Indian runs amuck after eating hasheesh or cannabis indica, 
or the Chinaman goes into a delightful dreamland from smoking 
opium, whereas the Anglo-Saxon experiences no such agreeable sensa- 
tions, as a general rule. Southerners generally require larger doses 
of purgatives than Northerners, often because their livers are not as 
active. 

The temperament of an individual is also a highly important matter 
to be considered. It is a notorious fact that phlegmatic dark-skinned 
persons usually yield to drugs less readily than blondes and nervous 
persons, more especially in respect to the drugs which act on the 
nervous system. Nervous light-haired women stand belladonna very 
badly as a general rule, while children will take large doses often 
without discomfort. Opium is usually badly borne by children. 

Habit is another important factor governing idiosyncrasy. We all 
know how rapidly one becomes accustomed to tobacco; and how mor- 
phine habitues take enormous amounts of their favorite drug without 
effect. 

ABSORPTION OF DRUGS. 

The knowledge of the rapidity with which certain drugs are absorbed 
from the various surfaces with which they come in contact, is of im- 
portance in order that we may know when to repeat the dose if the 
first amount does not produce the desired effect. The rapidity of 
absorption depends upon a number of factors. If the circulation is 
active absorption is active, but if it be, depressed absorption is slow. 
Thus, in a person apparently drowned, absorption may not occur at 



STRENGTH AND RELIABILITY OF DRUGS. 27 

all until the vital functions are restored, and repeated doses given to 
the patient while unconscious, acting together, in the end poison him. 
This is often the case in delirium tremens where hypodermic injections 
of morphine are given, or when the drug is administered by the mouth. 
In dropsy absorption is peculiarly slow, and the drug may remain 
in the tissues for days, only to be absorbed with the exudation after 
severe purgation or profuse diuresis, or tapping. In general dropsies 
hypodermic medication is nearly always worse than useless. 

When the stomach or bowel is empty absorption from either is rapid, 
but when they are full it is very slow. In this fact we find the reason 
for the popular idea that a glass of whiskey when a man is hungry 
makes him drunk, whereas twice the quantity after dinner does not 
do so. 

Drugs in the stomach or bowel have no influence over the general 
system unless they are irritants. They only act when taken into the 
blood or lymphatics. 

Recent studies show that alcoholic solutions of drugs are more 
rapidly absorbed than are watery solutions or those made with glycerin 
or milk. 

DURATION OF ACTION OP DRUGS. 

The duration of the action of drugs depends partly upon their 
rapidity of absorption, but chiefly upon the rapidity or slowness of 
their destruction in the body, or their elimination from it. Thus, 
volatile substances such as ether, chloroform, and nitrite of arnyl, 
act only for a short time and are quickly eliminated, whereas bromide 
of potassium and digitalis continue active during many hours, and are 
slowly eliminated, as in the case of the former, or oxidized, as in that 
of the latter. Again, if curare is given hypodermically it will cause 
paralysis, but if taken by the stomach in moderate amount it will be 
eliminated by the kidneys as rapidly as it is absorbed, and produce no 
effects if these organs are active. 

From studying the rapidity of the elimination of a drug we learn 
how often to order a dose. Thus, digitalis may be given once, twice, 
or thrice a day, but carbonate of ammonium every two or three 
hours. 

When the physician is not careful in the use of a drug which is 
eliminated slowly, it may suddenly develop so severe an effect as to 
cause alarm, owing to the accumulation of the poison in the body. 
This is called " cumulative action/ 7 



STRENGTH AND RELIABILITY OP DRUGS. 

If a census could be made of those who die annually from the use 
of drugs which are impure or useless from weakness, the writer 
believes that a most alarming array of figures would be presented. 
For many years this was unavoidable to a great degree, either because 



28 GENERAL THERAPEUTICAL CONSIDERATIONS. 

our knowledge of the active principles of drugs and the methods of 
isolating them was deficient, or because the time consumed in their 
transportation by sailing vessels or on the backs of natives from the 
countries in which the natural products yielding the drugs were 
obtained , permitted deterioration to take place. At present these 
difficulties have been largely overcome. The trained pharmacist is 
taught how to make an assay for active principles in most of the 
valuable alkaloidal drugs, and every physician should make careful 
investigation into the quality of all preparations which he employs. 
That these remarks are not out of place will be seen by the fact that 
very recently an intimate friend of the writer bought from five of the 
leading druggists of Philadelphia six ounces of tincture of mix vomica 
which were stated to have been made according to the directions of 
the United States Pharmacopoeia. That made by perhaps the leading 
druggist of the five contained twice as much strychnine and brucine 
as it should, and had twice as much solid residue ; or, in other words, 
a physician prescribing this tincture in full dose would probably have 
poisoned his patient and reported the case as one of unusual suscepti- 
bility to drugs ! On the other hand, the author has recently seen a 
tincture of nux vomica which contained only a trace of alkaloid, but 
had much inert solid residue. In neither instance was the druggist 
a dishonest one intentionally, but one had used a crude drug which 
was unusually rich in alkaloids, while the other had purchased nux 
vomica beans which, by reason of immaturity, bad surroundings, or 
exposure to weather, were very poor in active principles. All these 
disadvantages may be avoided if physicians will insist that the 
druggists who dispense the drugs they order shall either themselves 
prepare assayed products, or purchase such products from any one of 
the large manufacturing chemists who put assayed goods on the market. 
When this is impossible the physician should employ the alkaloids, 
in pill form, or, if solutions are desirable, the alkaloid may be added 
to alcohol and water and given by drops, as is the case with any 
ordinary tincture. Digitalis and veratrum viride are practically the 
only drugs with which this cannot be done ; in the first the action of 
the drug does not depend upon a single active principle, but upon a 
large number, and in the second the relative proportions of jervine 
and veratroidine cannot be well estimated by the physician. H. C. 
Wood records a case in which opium poisoning occurred in a child 
who had taken a Dover's powder ; the reason being that the amount 
of opium intended for many doses was in the powder that was dis- 
pensed, the other constituents not having been properly mixed with 
the opiate in compounding the prescription. Constant uncertainty is 
a dangerous element when we are dealing with patients who are 
desperately ill ; and in many cases failure and discouragement may 
both be avoided if the physician will see to it that the tools with 
which he works are in good order and capable of doing what he 
requires of them. A poor drug to the physician is worse than a 
rusty knife to the surgeon; for the injury in the one case is unknown, 
whilst in the other it can be carefully watched and guarded. 



INDICATIONS, CONTRA-INDICATIONS, DEFINITIONS. 29 

INDICATIONS AND CONTRA-INDICATIONS 
AND DEFINITIONS. 

The indication for a drug is any symptom or series of symptoms 
which we know the drug will relieve without causing at the same 
time an evil effect to be felt by other parts of the body. A contra- 
indication is any coexisting state or tendency which will be made so 
much worse by the drug as to forbid its use. Thus, one might be 
tempted to give quinine in meningitis for the fever, yet this would 
be bad therapeutics, since quinine is contra-indicated because it will 
intensify the meningitis. 

Abortifacients form a class of drugs which, as such, ought never to 
be employed. If pregnancy is to be interrupted the interruption 
should be produced by instrumental means, and then only after 
consultation. 

Alteratives are indicated where cell-growth is active to excess, but 
contra-indicated where tissue break-down is present, or there exists a. 
tendency thereto. 

Ancesthetics are drugs used to produce lack of sensation. They are 
either local or general. Many of the local anaesthetics produce loss of 
sensation through benumbing the parts by the cold they produce. 
Cocaine is an example of a local anaesthetic which causes anaesthesia 
by a direct paralyzant action on the peripheral sensory nerves. 

Anaphrodisiacs are remedies used to diminish sexual desire. 

Antacids are employed in cases of gastric fermentation when, as a 
result of the morbid processes, lactic and butyric acids, or even hydro-x 
chloric acid, are found in abnormal quantities. 

Anthelmintics are those remedies which are used for the purpose of 
removing intestinal worms. 

Antiarthritics is the name given those drugs which are employed 
for the purpose of relieving inflammations occurring in joints, whether 
these be in an acute or chronic condition of disease. Colchicum, which 
is one of this class, is contra-indicated, as a rule, in cases of gouty in- 
flammations of the joints if the bowels are already moving too freely, 
as, under these circumstances, retrocedent gout is apt to occur. 

Antihidrotics are used to prevent excessive sweating, either when 
it is local or general. Camphoric acid is probably the best general 
antihidrotic. 

Antiperiodics is a term applied to drugs or remedies employed for 
the prevention or cure of malarial poisoning. They are so named 
because they tend to break up the periodicity of the attacks, which 
periodicity is a characteristic of such diseases. 

Antiphlogistics are remedies employed to prevent the progress of 
inflammatory processes. They are nearly all contra-indicated in the 
presence of tissues possessing an impaired vitality through previous 
conditions of disease. 

Aphrodisiacs are remedies used to increase sexual desire and power. 

Astringents are employed for the purpose of contracting or con- 



30 GENERAL THERAPEUTICAL CONSIDERATIONS. 

stringing tissues. They act not by coagulation of albumin, but by 
their influence over the vital processes of the tissues with which they 
come in contact. Theoretically, all astringents should be non-irri- 
tating, but practically they possess irritant properties, and are, in con- 
sequence, contra-indicated in the presence of very acute inflammations, 
as a rule. Three of the mineral astringents, however, possess marked 
sedative properties in addition to their astringent power, and can 
therefore be used freely in acute inflammations when locally applied. 
They are nitrate of silver, subacetate or acetate of lead, and the subcar- 
bonate or subnitrate of bismuth. 

Bitters are remedies designed to increase the activity of the mucous 
membrane of the gastro-intestinal canal by increasing its tone. They 
may be divided into simple bitters and complex bitters. The first 
depend upon their bitterness solely for their activity ; the second 
class is well represented by quinine or strychnine, both of which are 
exceedingly bitter, but, in addition to their local effect on the gastro- 
intestinal mucous membrane, act as stimulants to other portions of 
the organism. A good example of a simple bitter is columbo. Many 
bitters contain so much tannic acid that they are not generally useful, 
and for this reason very few can be used with preparations of iron, 
since a tannate of iron would be formed. 

Cardiac sedatives are drugs which decrease the force of the heart, 
and, as a class, the amount of blood expelled at each beat of the ven- 
tricles. They are indicated in arterial excitement, contra-indicated in 
arterial depression. 

Cardiac stimulants are drugs which increase the force of the heart, 
thereby increasing the quantity of blood expelled from the ventricles. 
This may be accomplished by an increase in the rapidity of the beats, 
or by a greater output of blood at each contraction, the diastole being 
sufficiently prolonged to admit of the ventricles being w T ell filled. 
They are contra-indicated in the presence of arterial excitement, and 
indicated in arterial depression. 

Carminatives are remedies given for the purpose of expelling flatus, 
particularly if there is reason to believe that the ''wind" has accu- 
mulated because of intestinal torpidity. Many of the carminatives 
are necessarily possessed of irritant properties, and are therefore 
contra-indicated in the presence of flatulence due to intestinal atony 
arising from inflammation. The best carminative is spiritus setheris 
compositus, or Hoffmann's anodyne. 

Cathartics. These are drugs employed when a positive and decided 
action of the bowels is desired. They occupy a position between the 
purges and the drastics. (See Purges and Drastics.) The best ex- 
ample of a cathartic is probably jalap. 

Cholagogues are used when it is desired to exert a stimulant influ- 
ence over the flow of bile, without necessarily increasing intestinal 
peristalsis. Nitro-hydrochloric acid is, perhaps, the best type of a 
pure cholagogue, while podophyllum represents the class of chola- 
gogues which increase intestinal peristalsis in addition. Cholagogues 



INDICATIONS, CONTKA-INDICATIONS, DEFINITIONS. 31 

are contra-indicated in the presence of acute inflammation of the gall- 
bladder or liver. 

Counter-irritants are remedies used to produce irritation at a spot 
distant from a painful or inflamed area, in order to relieve the diseased 
parts by reflex action exerted through the nervous system upon the 
painful nerve or disordered capillary network. 

Demulcents are substances used to protect any exposed parts of the 
body from irritation. 

Diaphoretics produce an increased secretion from the sweat glands. 
They may be considered as internal and external. The internal are 
represented by pilocarpine, which stimulates the sweat-glands them- 
selves ; the external are represented by the Turkish and Russian baths, 
which, by increasing bodily heat, cause a profuse sweat by reflex 
action. 

Diuretics are used to increase the flow of urine from the kidneys. 
They act by stimulating the renal epithelium to greater activity, 
thereby increasing the excretion of both the watery and solid con- 
stituents of the urine ; or they simply increase the watery constituents 
by increased blood pressure in the kidney. 

It is to be remembered that the vegetable salts of potassium and 
the lithium salts increase the solids in the urine, not by stimulating 
the secreting epithelium of the kidney, but by uniting with insoluble 
material in the system, forming soluble compounds which are then 
readily eliminated. (See Eliminators.) They are indicated in con- 
ditions of renal inactivity due either to functional or organic causes. 
Irritating diuretics, such as cantharides, for example, are contra-indi- 
dicated in acute nephritis. Such a diuretic is only to be used where 
the kidneys are inactive through atony or prolonged chronic or sub- 
acute disease. 

Eliminators are drugs which, by forming soluble compounds with 
insoluble substances in the body, render them capable of being ex- 
creted by the excretory organs, such as the skin, kidneys, and bowels. 

Emetics are drugs used to produce vomiting. They act centrally 
when, as is the case with apomorphine, they stimulate the vomiting 
centre, peripherally when they irritate the walls of the stomach. They 
are indicated when we wish to unload the stomach of undesirable mate- 
rials, or when we desire to cause an increased flow of bile from the 
gall-bladder, which is accomplished by the pressure exerted upon this 
viscus when the abdominal walls and diaphragm contract in retching. 
When the ducts are mechanically obstructed with a gall-stone emetics 
are dangerous, as they may cause rupture of the gall-bladder. 

Sometimes we are able by the use of emetics to rid the lungs and 
stomach of mucus in bronchitis or gastric catarrh. 

The contra-indications to emetics are cerebral congestion or menin- 
gitis, gastritis, gastric ulcer, advanced pregnancy, and hernia. 

Emmenagogues are remedies used to produce or increase the men- 
strual flow. They are of two classes — direct and indirect. The direct 
are all of them irritants, and are seldom of much value ; the indirect 
are used to overcome the morbid condition underlying the menstrual 



32 GENERAL THERAPEUTICAL CONSIDERATIONS. 

disorder, and are therefore more rational. Thus iron and arsenic may 
be used in amenorrhoea due to anaemia with beneficial result. 

Expectorants are employed when it is desirable to promote secretion 
or to get rid of secretion in the bronchial tubes. Thus, in the early 
stages of an acute bronchitis, the mucous membrane is hypersemic and 
swollen, but dry and irritable. Ipecac and citrate of potassium form 
at this time a sedative expectorant mixture, which, while allaying irri- 
tation, promotes secretion, and so relieves the engorged area. On the 
other hand, after the acute stage is passed, there may be so much 
atony of the mucous glands that the secretion is either too scanty or 
too viscid to be coughed up. Stimulant expectorants, such as chloride 
of ammonium, eucalyptus, and terebene are now to be employed. 
These latter drugs are contra-indicated in the acute inflammatory 
stage of the disease, as they would simply stimulate the irritated 
mucous membrane to greater irritation. 

Hypnotics are drugs used to produce sleep. They may be divided 
into those which produce sleep and relieve pain, and those which have 
no analgesic power. The latter are therefore not to be employed in 
sleeplessness due to pain, and the former are contra-indicated when 
pain is absent. Thus chloral produces sleep if it be ordinary func- 
tional insomnia ; but if the sleeplessness is due to pain, opium is the 
drug to be employed. Chloral, in ordinary doses, is the purest 
hypnotic that we have. 

Mydriatics are drugs which produce dilatation of the pupil or 
mydriasis. Conditions of the eye associated with increased intra- 
ocular tension, are contra-indications to mydriatics, as a rule. 

Myotics are drugs which cause contraction of the pupil or myosis. 
They are best represented by cserine. 

Nervous sedatives are indicated and contra-indicated in a reverse 
manner to nervous stimulants. 

Nervous stimulants are contra-indicated in nervous excitement, 
indicated in nervous depression. 

Oxytoxics are drugs which increase the expulsive power of the 
uterine muscular tissues. 

Revulsives are remedies used to produce increased activity of the 
general system or parts thereof through reflex influences — that is, 
they cause a determination of blood to one part, thereby relieving an 
engorged area. Thus, in cerebral congestion or effusion, a vigorous 
purgative or cathartic may give relief by exercising a derivative effect. 
Revulsives are closely allied to counter-irritants. 

Boborants are drugs or measures devoted to the repair and building 
up of tissues in the body, aud comprise both foods and drugs. Robo- 
rant treatment also includes hygienic surroundings, fresh air, light and 
healthful employment. 

Tonics are used to increase vital activity. They are indicated in 
instances of local or general systemic depression, contra-indicated in 
cases of inflammation or excitation with excessive functional activity. 
(See Bitters.) 

Vasomotor depressants are drugs which decrease arterial pressure by 



INCOMPATIBILITY. 33 

an action on the vasomotor nervous system rather than by an action 
on the heart. They act indirectly by relaxing the bloodvessels. 

Vasomotor stimulants are drugs which increase arterial pressure by 
an action on the vasomotor system, thereby producing contraction of 
the bloodvessels. 

COMBINATION OP DRUGS FOR JOINT EFFECT. 

The study of the physiological action of drags has aided us very 
greatly in improving our therapeutic measures. Thus, we now know 
that chloral is a heart-depressant and cannot be used in very full doses, 
or pushed to produce sleep in persistent insomnia, without grave 
danger ; whereas morphine, which also produces sleep, but does not 
depress the heart, but does depress the respiration, can be combined 
with it, and the two acting together, each in small dose, produce a 
heavy sleep, although so little chloral is present that the heart is safe, 
and so small an amount of morphine is used that the respiration does 
not suffer. 

Another example of this is found in certain purgative pills where 
the purgative agent is assisted by belladonna and mix vomica, the first 
of which relaxes muscular spasm, while the second acts as a tonic to 
the alimentary tract, the drugs combining to accomplish one result. 

Skill in the combination of drugs, not only for increased physio- 
logical effect, but also for the purpose of making their administration 
pleasant to the taste, has much more to do with professional success 
than is generally supposed. This is particularly so in regard to 
children, for parents dislike forcing their children to take doses which 
they themselves regard as horrible, and they are ever ready to believe 
that as long as a medicine tastes good it is better than one which tastes 
otherwise. 

The medical practitioner who prescribes ever so wisely and appro- 
priately for a patient, but who is utterly regardless as to his combina- 
tions of drugs so far as taste is concerned, will sooner or later see a 
more ignorant man take from him that practice which his greater 
wisdom entitles him to, but which is driven from him by his own 
errors in this matter. 

While in some cases there is no alternative but to give a bad dose, 
in others a little thought and care will often avoid offending the taste 
of the patient. 

INCOMPATIBILITY. 

The chief value of a knowledge of chemistry or pharmacy to a prac- 
titioner of medicine is the avoidance of what is known as an " incom- 
patibility/' or the placing in one prescription of two or more substances 
which will undergo chemical interchanges, decompositions, precipita- 
tions, or cause the formation of explosive mixtures. It is impossible 
to detail all the incompatibilities, and only the most dangerous and 
common possibilities of error can be considered. 



34 GENEKAL THEK APEUTIC AL CONSIDERATIONS. 

1st. An acid should never be combined with an alkali. 
2d. An acid should not be added in any quantity to a tincture. 
The following prescription is an illustration of this : 

R. — Potassii iodidi ^ij. 

Acidi nitro-muriatici f zj. 

Tr. cinchonse comp q. s. f^iij- M. 

S — Use as directed : a teaspoonful. 

In this ridiculous mixture the acid is incompatible with the iodide 
of potassium, forming a chloride and setting free iodine, and would 
also change part of the alcohol in the tincture into an ether. 

3d. Alkalies should not be combined with the alkaloids. Thus : 

R . — Strychninse sulph. . . . . gr. j. 

Potassii iodidi . . . . . • 3 ij • 

Syr. sarsaparillse comp. . . . . f^iij. M. 
S. — Teaspoonful t. d. 

In this prescription the strychnine would be precipitated by the 
potassium salt, and the patient would get nearly all the strychnine in 
the last dose. 

4th. Potassium chlorate should not be ordered to be rubbed up 
with tannic acid or any other organic substance capable of oxidation, 
as it will explode. Permanganate of potassium is subject to the same 
rule. 

5th. Chlorate of potassium and ammonium chloride when mixed 
together may take fire. 

6th. Iron is incompatible with tannic acid, as it forms a tannate of 
iron, or ink. As all the vegetable astringents contain tannic acid they 
should none of them be used with iron except chiretta and columbo. 

7th. Tannic acid should never be added to solutions of alkaloids. 

8th. Gum arabic is not to be added to solutions of iron, lead, or 
the mineral acids. 

9th. Alcoholic solutions of camphor and similar resinous substances 
are incompatible with water. 

10th. Fluid extracts are incompatible with water, as the addition 
of water will precipitate them. 

11th. All salts not acid but alkaline in reaction are decomposed by 
acids. 

12th. All salts which are acid are decomposed by alkalies. 

13th. All vegetable acid salts are altered by mineral acids and are 
decomposed by alkalies. 

14th. Iodine and the iodides should not be given with alkaloids. 

15th. Corrosive sublimate, the salts of lead, iodide of potassium, 
and nitrate of silver should always be prescribed alone, except in the 
following instances : 

(a) Corrosive sublimate may be given with potassium iodide, since 
it will throw down a precipitate which redissolves and forms a double 
salt. 

(6) Nitrate of silver may be used with extract of opium or hyoscy- 
amus. 



CLASSIFICATION OF DRUGS. 



35 



16th. Syrup of squill should not be given with the carbonate of 
ammonium, as it contains acetic acid. Chloride of ammonium is not 
incompatible with it. 

17th. Cherry-laurel water should not be prescribed with morphine, 
as it may form the poisonous cyanide of morphine. 

1 8th. Chloral and cyanide of potassium should never be placed in 
the same prescription, as they will decompose each other, setting free 
hydrocyanic acid. 

19th. Cocaine and borax when added together form an insoluble 
borate of cocaine. Boric acid and cocaine do not result in this formation. 

20th. Calomel and antipyrine are said to be incompatible, as are 
also sweet spirit of nitre and antipyrine. 

21st. Waters cannot be used in preparing saturated solutions of 
drugs, as they are already loaded with a volatile substance. 



CLASSIFICATION OF DRUGS. 

In order that the student may gain a definite idea as to the various 
actions of different remedies the following list of drugs is appended, 
which is of necessity somewhat arbitrary. The endeavor has been 
made to place the best or most powerful drug of each class first in the 
list. It is to be remembered that a strict physiological classification 
is impossible. 



I. Alteratives. 


IV. Anthelmintics. 


1. Mercury. 


Those that are used against the round- 


2. The Iodides of potassium and so- 


worm are : 


dium. 


1. Santonica. 


3. Iodine. 


2. Spigelia. 


4. Iodoform. 


3. Chenopodium. 


5. Iodol. 


4. Azedarach. 


6. Arsenic. 


5. Santoninate of Sodium. 


7. Cod-liver oil. 




8. Colchicum. 


Those used against the tape-worm are : 


9. Ichthyol. 


1. Pelletierine. 


10. Taraxacum. 


2. Aspidium. 


11. Mezereum. 


3. Pepo. 




4. Pomegranate. 


II. Anesthetics. 


5. Brayera. 




6. Kamala. 


1. Ether. 

2. Nitrous oxide gas. 


7. Turpentine. 

8. Chloroform. 


3. Chloroform. 




4. Cocaine. 


Those used against the seat-worm, or 


5. Bromide of ethyl. 


oxyuris vermicularis, are : 


6. Chloride of ethyl. 


1. Quassia. 


7. Pental. 


2. Turpentine. 


8. Bromoform. 


3. Tannic acid. 




4. Chloride of sodium. 


III. Antacids. 


5. Vinegar. 


1. Ammonia. 




2. Sodium and its salts. 


V. Antiseptics. (See also Disinfect- 


3. Liquor potassa. 


ants.) 


4. Calcium and its stilts. 


1. Corrosive sublimate in weak so- 




lutions. 



36 



GENERAL THERAPEUTICAL CONSIDERATIONS 



2. Carbolic acid in weak solutions. 

3. Peroxide of hydrogen. 

4. Boric acid. 

5. Sulphate of iron. 

6. Permanganate of potassium. 

VI. Antiperiodics or Antimalarials. 

1. Cinchona. 

2. Eucalyptus. 

3. Warburg's tincture. 

VII. Antipyretics. 

1. Antipyrine. 

2. Acetanilide or antifebrin. 

3. Phenacetine. 

4. Phenocoll. 

5. Salicylic acid. 

6. Thallin. 

7. Carbolic acid. 

8. Kairin. 

VIII. Antispasmodics. 

1. Chloral. 

2. Bromides. 

3. Hoffmann's anodyne. 

4. Camphor. 

5. Opium. 

6. Belladonna. 

7. Asafoetida. 

8. Musk- 

9. Valerian. 

10. Monobromate of camphor. 

11. Amber. 

12. Cimicifuga. 

13. Plops. 

IX. Astringents. 

Vegetable : 

1. Tannic acid. 

2. Hsematoxylon. 

3. Kino. 

4. Catechu. 

5. Rhatany or krameria. 

6. Rhus glabra. 

7. Geranium. 

8. White oak. 

9. Black oak. 

10. Gallic acid. 

11. Rosa centifolia. 

12. Rosa gallica. 

All of these depend chiefly upon tannic 
acid for their active principle 

Mineral : 

1. Sulphuric acid. 

2. Alum. 

3. Lead. 

4. Nitrate of silver. 

5. Nitric acid. 

6. Sulphate of copper. 

7. Bismuth. 

8. Sulphate of zinc. 



X. Cai 


.diac Sedatives. 


1. 
2. 
3. 
4. 
5. 


Aconite. 

Veratrum viride and album. 

Antimony. 

Hydrocyanic acid. 

Veratrum sabadilla- 


XL Cardiac Stimulants. 


1. 

2. 
3 
4. 
5. 


Digitalis. 

Ammonia. 

Ether. 

Alcohol. 

Caffeine. 


6. 

7. 

8. 

9. 
10. 
11. 
12. 
13. 


Nux vomica. 

Ignatia. 

Strophanthus. 

Adonis vernalis 

Convallaria majalis. 

Sparteine 

Amyl nitrite (momentarily). 

Opium. 


XII. Counter-irritants. 


Those counter-irritants that blister are 
called epispastics They are: 

1. Cantharides. 

2. Thapsia. 

3. Ammonia when under a watch 

glass. 


Those that redden or produce local 
hyperemia of the skin are : 


1. 

2. 
3. 
4. 
5. 
6. 
7. 
8. 


Mustard. 
Capsicum. 
Turpentine. 
Ammonia 
Chloroform. 
Burgundy pitch. 
Canada pitch. 
Most of the spices. 



Under the name of Escharotics are 
grouped a number of substances capa- 
ble of acting as destructive agents upon 
the soft tissues of the body. They are : 

1. Chromic acid. 

2. Nitric acid. 

3. Sulphuric acid. 

4. Nitrate of mercury (solution). 

5. Bromine- 

6. Caustic potash. 

7. Caustic soda 

8 Arsenious acid. 

9. Chloride of zinc. 
10 Vienna paste 
11. Canquoin's paste 

XIII. Diaphoretics. 

The only ones that we know as direct 
stimulants to the glands are : 

1. Pilocarpus or jaborandi. 

2. Warburg's tincture. 



CLASSIFICATION OF DRUGS. 



37 



The others are: 

3- Hot dry and hot moist baths. 

4. Dover's powder. 

5. Alcohol (particularly when hot). 

6. Nitrous ether. 

XIV. Digest ants. 
1. Pancreatin. 

2 Pepsin. 

3. Hydrochloric acid. 
4 Papain. 

5. Diastase. 

XV. Disinfectants. 

1. Corrosive sublimate. 

2. Chlorine or chlorinated lime 

3 Carbolic acid 

4. Chloride of zinc. 

XVI. Diuretics. 

Those that increase both the solids and 
liquid constituents are probably : 
1. Caffeine. 

2 Squill. 

3 Cantharides. 

4. Buchu. 

5. Blatta. 

6. Juniper. 

7. Turpentine. 

8. Uva ursi. 

9. Chimaphila. 
10 Cubebs. 

11. Pareira brava. 

Those which increase the watery con- 
stituents of the urine without in- 
creasing the solids proportionately 
are: 

1. Digitalis. 

2. Vegetable salts of potassium. 

3. Nitrous ether. 

4. Lithium. 

XVII. Eliminatives. 

1. The iodides. 

2. The salicylates. 

3. The vegetable salts of potassium. 

4. The lithium salts. 

5. Jaborandi 

6. Colchicum (probably). 

XVIII. Emmenagogues. 

The direct emmenagogues are : 
1. Apiol 
2 Binoxide of manganese. 

3. Permanganate of potassium. 

4. Cantharides. 

5. Aloes 

6. Myrrh. 

7. Rue 

8. Savine. 

9. Tansy. 



10. Pennyroyal. 

11. Guaiac 

The indirect are : 

1. Iron. 

2. Copper. 

3. Arsenic. 

4 Tonics in general. 



XIX 



Emetics. 
The direct are represented by : 

1. Apomorphine. 

2. Ipecac (which is both centric and 

peripheral). 

The peripheral are 



Sulphate of zinc. 

Mustard. 

Alum. 

Sulphate of copper. 

Turpeth mineral. 



XX. Expectorants. 
Sedative : 

1. Citrate or acetate of potassium. 

2. Ipecac. 

3. Antimony. 

Those which act as stimulating expec- 
torants are : 



Ammonium chloride. 

Apomorphine. 

Creasote. 

Eucalyptus. 

Tar. 
6 Terebene. 
7. Oil of sandal wood. 
8 Lobelia 
9. Sulphur. 
10 Grindelia robusta. 

11. Garlic. 

12. Squill. 

Besides these we have nux vomica 
which increases expectoration by stimu- 
lating the nervous system to coughing, 
and thus expels the mucus. Opium and 
the bromides depress the nervous system 
and allay cough, and so decrease expecto- 
ration. 

XXI. Hypnotics. 

1. Chloral. 

2. Bromides of potassium, sodium, 

etc. 

3. Opium. 

4. Sulphonal. 

5. Paraldehyde. 

6. Urethan. 

7. Somnal. 

8. Amylene hydrate. 

9. Methylal. 

10. Hypnone. 

11. Hyoscine, in mania. 

12. Cannabis indica (in large dose). 



38 



GENERAL THERAPEUTICAL CONSIDERATIONS 



XXII. Nervous Sedatives. 



7. 



10. 
11. 
12. 
13. 
14 
15. 
16. 
17. 
18. 
19. 
20. 
21. 
22. 
23. 
24. 
25. 
26. 
27. 
28. 
29. 
30. 
31. 
32. 
33. 
34. 
35. 
36. 
37, 



Chloral. > 

Opium (in full 

The bromides and hydrobromic 

acid. 
Chloroform. 
Amyl nitrite. 
Nitrites of potassium, sodium, 

and nitroglycerin. 
Ether. 

Bromide of ethyl. 
Nitrous oxide. 
Bromoform. 
Cannabis indica. 
Belladonna. 
Antipyrine. 
Acetanilide. 
Phenacetine. 
Calabar bean. 
Hydrocyanic acid. 
Lobelia. 
Conium 
Tobacco. 
Sulphonal. 
Croton chloral. 
Paraldehyde. 
Camphor. 

Monobromated camphor. 
Asafoetida. 
Amber. 

Hoffmann's anodyne. 
Cimicifuga. 
Musk. 
Valerian. 
Humulus. 
Castor. 
Hypnal. 
Somnal. 

Amylene hydrate. 
Urethan. 



XXIII. Nervous Stimulants. 

1. Nux vomica. 

2. Ignatia. 



3. Coffee. 

4. Coca. 

XXIV. Oxytocics. 

1. Ergot. 

2. Cotton root. 

3. Ustilago maydis. 

And indirect when in labor : 
1. Quinine. 

XXV. Tonics. 

1. Cinchona. 

2. Nux vomica. 

3. Calumba. 

4. Arsenic. 

5. Phosphorus. 

6. Mercury (in minute doses). 

7. Copper. 

8. Iron. 

9. Hydrochloric acid. 

10. Nitro-hydrochloric acid. 

11. Nitric acid. 

12. Phosphoric acid. 

13. The vegetable bitters in general. 

XXVI. Vasomotor Depressants. 

1. Veratrum viride. 

2. Antimony. 

3. Aconite. 

4. Veratrum album. 

5. Veratrum sabadilla. 

6. Alcohol (in excessive doses). 

7. Jaborandi. 

XXVII. Vasomotor Stimulants. 

1. Belladonna. 

2. Hyoscyamus 
3 Digitalis. 

4. Nux vomica. 

5 Ergot. 

6 Stramonium. 

7. Caffeine. 

8. Convallaria. 



PART II. 

DRUGS. 

AOAOIA. 

Acacia, U. S., Acacice G-ummi, B. P., Gum Arabic, or Gum Acacia, 
is a gummy exudate from the stems and branches of small trees known 
as Acacia VereJc, Acacia Senegal, and other acacias growing in 
northern Africa and in Australia. As sold in the stores it consists of 
irregular semi-transparent lumps, which are either smooth or angular, 
according to whether the substance has been preserved in the original 
beads or broken by handling. Its color is slightly yellow or almost 
white, both color and transparency depending largely on the amount 
of the impurities by which it is contaminated. 

It is devoid of physiological action. 

Therapeutics. — Acacia is employed in medicine as a local applica- 
tion to inflamed and irritated mucous membranes, particularly of the 
upper air-passages, and also in the form of a drink in the same condi- 
tions. In instances where genito -urinary irritation exists it is useful 
as a vehicle for more powerful remedies. Made into a mucilage with 
flaxseed, to which liquorice may be added, it is largely employed to 
loosen a hacking cough in children or in adults. The flaxseed should 
not be boiled, but allowed to stand on a moderately warm part of the 
" range/' and the gum arabic solution added with a little lemon-juice 
for flavoring purposes. Acacia is chiefly used in pharmacy for making 
pills, emulsions, and similar preparations, and is official in the form 
of the mucilage of acacia {Mucilago Acacice, U. S. and B. P.) ; and 
the syrup of acacia (Syritpus Acacice, U. S.), the first containing 34 
parts of acacia and 6b' parts of water, and the second 25 parts of the 
mucilage to 75 parts of simple syrup. 

AOETANILIDE, or ANTIFEBRIN. 

This substance, first employed in medicine by Calm and Hepp, is a 
white crystalline material only slightly soluble in water, but com- 
pletely soluble in alcohol and ether. Applied to the tongue it causes 
a burning sensation which is not very severe. It has been known to 
chemists for many years, and is made by the action of glacial acetic 
acid upon aniline, forming in this way acetanilide or phenyl-acetamide. 



40 DRUGS. 

The word antifebrin is a trade-mark, and should be avoided by the 
profession, since its employment obliges the druggist to use the acetan- 
ilide made by one firm instead of the compound made by other chemists, 
who are able to make the drug as an ordinary chemical compound, 
and do not charge so high a price as do those holding control over the 
trade-mark name. 

Physiological Action. — Acetanilide has been studied experiment- 
ally and chemically to a very great extent, and fairly definite outlines 
of its action have been mapped oat. 

Nervous System. — On the nervous system acetanilide has been 
found to act as a sedative, the sensory portion of the nerves and spinal 
cord particularly being quieted. After a poisonous dose general anaes- 
thesia comes on, with total loss of reflex action and with motor and 
sensory paralysis. The portions of the nervous system involved in 
these changes are, primarily, the sensory side of the spinal cord and 
the sensory nerves, the motor apparatus being least affected. The 
muscles are not influenced by the poison, except indirectly. 

Circulation. — On the circulation acetanilide has but little direct 
influence except when used in poisonous doses. Applied to the frog's 
heart it at first accelerates its beat and increases its force, but soon 
causes a weakening, ending with arrest in wide diastole. Upon the 
higher animals it causes, in toxic dose, an immediate fall of arterial 
pressure with a diminution in the size of the pulse r waves and all the 
evidences of cardiac and circulatory depression, notwithstanding the 
fact that death ensues from respiratory failure. The cause of this 
fall of blood-pressure is a direct depressing action on the heart asso- 
ciated with failure of the vasomotor system, as asphyxia causes no 
rise in pressure. 

In medicinal dose acetanilide causes no circulatory changes of any 
moment. Sometimes the pulse-rate is increased, sometimes diminished. 
The tendency is, however, toward depression rather than stimulation 
of the circulation. 

Blood. — The action of this drug upon the blood, when used in 
large doses, is more pronounced than its influence upon any part of 
the body, causing this tissue to become brownish-red, decreasing its 
ozonizing and oxygen-carrying power, and, finally, reducing the 
haemoglobin to niethaemoglobin to a very considerable extent. The 
question as to the influence of acetanilide upon the corpuscles is still 
somewhat undecided, some observers declaring that these bodies are 
disorganized, while others assert that they remain intact. In moder- 
ately large poisonous doses it may not affect the corpuscles, but if its 
use in large amount be maintained for some days, or a very large 
amount be used at one time, corpuscular destruction certainly occurs, 
free haemoglobin appearing in the urine in its characteristic forms. 
The normal alkalinity of the blood is decreased, and the urine becomes 
dark and brownish in color, so that the blood-crystals of Teichmann 
may be found in it. In ordinary medicinal doses the blood shows no 
change except in cases where idiosyncrasy is present or the doses are 



ACETANILIDE, OR ANTIFEBRIN. 41 

unusually large. Under these circumstances the blood in the arterial 
system becomes more blue than normal. 

Respiration — No effect is produced upon this function by acetan- 
ilide when given in moderate doses. When poisonous doses are used 
the breathing at once becomes rapid and then impaired and labored. 
Large doses produce death by paralysis of the respiratory centres. 
The causes of these changes are, primarily, the alterations in the 
blood, which so influence oxygenation of the tissues as to lead the 
respiratory centres to greater effort, while at the same time they are 
beginning to be directly depressed by the drug itself, so that impair- 
ment of their function is soon manifest. Bokai asserts that the drug 
paralyzes the peripheral motor nerves, which, if true, brings forward 
a third factor in the respiratory failure. 

Temperature. — When given in full medicinal doses, acetanilide 
lowers the normal bodily temperature or else fails to produce any 
change. In poisonous doses it produces a decrease in temperature 
depending on the amount employed, and may produce collapse and 
rigors. On a fevered temperature it . acts as a powerful and fairly 
constant antipyretic, lowering the fever by decreasing heat-production 
and increasing heat- dissipation, heat-production being the function 
most affected. 1 Whether the decrease in heat-production is due to an 
action on the heat-centres in the nervous system, or upon other causes, 
is not positively known. Some investigators have claimed that the 
fall depends upon the partial reduction of the haemoglobin of the 
blood, whereby less oxygen is carried to the tissues and less combus- 
tion ensues. This seems doubtful, in view of the fact that the most 
careful spectroscopic examination of the blood fails to show any such 
change. That the fall of temperature is not dependent on the sweat 
produced is proved by the fact that the temperature falls even if 
enough atropine be given to stop all perspiration. 

Kidneys, Tissue-waste, and Urine. — Much contradictory 
evidence exists in regard to the changes which occur in these organs 
and their excretory products under the influence of acetanilide, but 
most observers agree that the excretion of urea is increased, and it is a 
fact that the more laborious researches which have been undertaken 
have reached a similar result. (Lepine, Chittenden, and Taylor.) Less 
uncertainty exists as to its influence on uric acid, which is increased 
rather than diminished by the drug. After excessively large doses 
the urine becomes dark from the presence of broken-down blood- 
coloring matter. 

Elimination. — The drug is eliminated by the kidneys in the form 
of para-amido-phenol-sulphate. 

Antiseptic Action. — -The drug possesses some slight antiseptic 
powers, but they are only exercised when the amount present is quite 
large. 

Toxic Changes from Prolonged Use. — Although it has been claimed 

1 The conclusions of Evans and of the writer have been severely criticised by H. 
C. Wood My reasons for holding to the opinions stated can be found in my Boyl- 
ston Prize Essay on Antipyretics Philadelphia, 1891. 



42 DRUGS. 

that no untoward effects result from the prolonged use of acetanilide 
in large doses, there can be no doubt that this is untrue. Under 
these circumstances congestions of the liver, kidneys, aud spleen 
occur, and if the doses be poisonous, clots may be found in the cardiac 
cavity. 

There may be also a progressive decrease in the number of the red 
blood-corpuscles. 

Poisoning. — In man this drug in toxic quantity causes the lips 
to become blue, the face livid, cyanosed, expressionless, or anxious. 
The forehead and cheeks become covered by beads of sweat, which 
gradually extend over the rest of the body. The pulse is soft and 
compressible, but slow and finally very weak. The respirations are 
slow and shallow. 

The treatment of a case of poisoning by acetanilide should consist 
in supporting measures, the use of stimulants, external heat, bella- 
donna to maintain blood-pressure, strychnine to aid the respiration, 
and oxygen inhalations if they are necessary to overcome cyanosis. 

Therapeutics. — The employment of acetanilide in fevers must 
depend very much upon the exact condition of the patient and the 
form of his disease. The mere existence of a malady, or of a high 
temperature, cannot, correctly speaking, be an indication for any 
particular remedy. The phase of the disease must be recoguized, and 
the question as to whether the fever which is present is harmful must 
be duly weighed. (See Fever, Part IV.) 

In typhoid fever the studies of most clinicians show that though 
the drug possesses very decided antipyretic nower, it often causes great 
depression and collapse, and in no way influences ttie duration or 
general course of the disease. 

For the same reasons the value of acetanilide in phthisis is doubtful, 
since, although it greatly affects the temperature, it is very apt to 
cause collapse, profuse sweating, aud depression. Thus the writer 
has seen cases of phthisis where the attempt to control the fever 
resulted in the manner just stated, and Riese points out, what the 
author has also noted, namely, that in this disease cyanosis is very apt 
to come on after the use of the drug. 

In regard to the employment of acetanilide in sthenic fevers, it at 
once becomes evident to the most careless student of medicine that a 
drug absolutely unsuited to a case of asthenic disease may, on the 
other hand, agree with a sthenic fever patient very well. In conse- 
quence of this, we find that the sweating produced by acetanilide is 
not so marked or troublesome in diseases of a dynamic type, and that, 
in consequence, it more rarely causes collapse. 

In much the same manner that antipyrine was found, some time 
after its introduction, to be possessed of pain-relieving power, so 
acetanilide has been discovered to possess similar properties — a dis- 
covery the credit of which must be given to the French investigator 
Lepine, who has written upon this subject, at various times, very ex- 
tensively. Almost every form of nerve pain seems to indicate its 
employment, and it has been success fully used in the crises of ataxia, 



ACETATE OF POTASSIUM. 43 

the agonizing clartings of gastralgia, and even in chorea, with good 
results. In a corresponding manner Secretan has obtained brilliant 
effects in cases of sciatica, and Silva has seen the most obstinate head- 
ache yield to its influence. A large amount of experience has proved 
it to be of value in epilepsy. 

The employment of acetanilide in rheumatism may be separated, if 
desired, into that devoted to the cure of the disease, with the relief of 
pain and the reduction of pyrexia. There can be no doubt whatever 
of the ability of the drug to control the fever of this disease, and the 
question as to whether it favorably influences the progress of the 
malady is to be answered very forcibly in the affirmative (see Rheu- 
matism, Part IV.). The dose for cases of rheumatism should be 4 to 
6 grains three times a day. 

Acetanilide has even been recommended as a haemostatic in epistaxis 
and haemoptysis. 

Untoward Effects are not very common if acetanilide be used with 
care. The writer has collected a number of cases (thirty-eight) in 
which unfavorable signs appeared after its use, but untoward action 
was never seen unless the dose given was excessive for the case which 
received it. The dose most commonly producing such symptoms was 
from 3 to 10 grains. In only three instances of the series did death 
occur, one from heart-clot and two from excessive dosage. No deaths 
were reported from moderate amounts, although some of the cases 
were very alarming. 

Administration. — Acetanilide may be given in doses varying from 
2 to 10 grains, the last-named amount being usually far too much. 
As it is virtually insoluble in water, it should always be administered 
in wine or spirit, in which it will dissolve, or in capsules or pills. 
The antipyretic effect begins to be felt about one hour after the drug 
is taken. When neuralgias are to be treated, or similar forms of pain 
are present, monobromated camphor, in the dose of \ a grain, may be 
combined with acetanilide with advantage. 

R. — Acetanilidi ....... gr. xx. 

Camphor, monobromati . . . . gr. v. M. 
Ft. in pil. no. x. S. — One every two hours. 



ACETATE OP POTASSIUM. 

Potassii Acetas, U. S. and B. P., is a neutral white salt of saline 
taste, readily deliquescent and soluble in water. It was at one time 
very largely used in the treatment of rheumatism in the " alkaline 
method/* as when it enters the blood it is changed into the alkaline 
carbonate. It has, however, been supplanted by the salicylates in the 
treatment of most cases. The dose should be from 1 to 2 ounces a 
day. A combination of 10 grains of the iodide of potassium and 30 
of the acetate is useful in rheumatism in some instances. 

In hepatic torpor acetate of potassium is exceedingly useful, and 
aids in promoting the flow of bile as well as that of the urine. It 



44 DRUGS. 

has been used in the treatment of the uric acid diathesis, and acts pow- 
erfully in rendering alkaline an acid urine. At one time it was sup- 
posed to purify the blood by aiding in the oxidation of effete material. 
The dose of potassii acetas is from 20 grains to 2 ounces, but the 
latter dose is only employed when a purgative effect is desired. 

ACETATE OF ZINC. 

Zinci Acetas, U. S. and B. P., occurs in the form of white mica- 
ceous crystals, which are efflorescent and quite soluble in water. It 
acts as a decided astringent to the skin and mucous membranes, but 
is less astringent than the sulphate of zinc. It is used as a collyrium 
in eye diseases, such as conjunctivitis, in the strength of 1 to 2 grains 
to the ounce. In gonorrhoea it is often employed instead of the ace- 
tate of lead in injections of the strength of 1 to 20 grains to the. 
ounce of rose-water. 

The treatment of poisoning by acetate of zinc is that adapted to 
gastro-enteritis. (See Gastro-Enteritis, Part IV.) 



ACETIC ACID. 

Acidum Aceticum, U. S. and B. P., as used in medicine, is a clear 
liquid made up of 36 per cent, of acetic acid and 64 per cent, of 
water, and has a sweetish odor. It is obtained from wood by destruc- 
tive distillation. 

Acetum, or Vinegar, is a dilute acetic acid. 

Therapeutics. — Acetic acid is seldom used internally, except in com- 
bination with potassium or sodium. As a powerful escharotic, the 
glacial or absolute acetic acid {Acidum Aceticum Glaciate, U. S. and 
B. P.) is used. It can be applied to waists and other growths, and to 
old sores where the granulations are profuse and slow to heal. The 
dilute acid (Acidum Aceticum Bilutum, U. 8. and B. P.) is used as a 
lotion in night-sweats, and to arrest epistaxis and other small haemor- 
rhages. As a lotion to be widely employed it should be diluted one- 
half Vinegar, or dilute acetic acid, has been used internally for the 
decrease of obesity, but is a harmful and useless remedy, disordering 
digestion and reducing the patient's strength. 

In the following mixture acetic acid has been used with success for 
the removal of vegetations about the external genitals : 

R . — Acid, salicylic ..... gr. xxx. 

Acid acetic. . . . . . f 3 j. M. 

S. — Apply with a camel' s-h air brush. 

Very little pain is caused by this application. 

Poisoning. — When over-doses of acetic acid are taken the treat- 
ment consists in the use of large doses of milk, alkaline liquids, such 
as lime-water, soap-water, etc., and the general measures adopted for 
the treatment of gastro-enteritis. (See Gastro-enteritis, Part IV.) 



ACONITE, OR MONKSHOOD. 45 

Contra-indications. — Nursing mothers should not take freely of 
vinegar, as it may produce a troublesome diarrhoea in the nursling. 



ACONITE, or MONKSHOOD. 

The Aconite of the U. S. P. is derived entirely from the tuberous 
root of Aconitum Napellus. At one time the leaves were official, 
but are so no longer, and for this reason the term " radix " is not to 
be employed, as it is a useless distinction. 

Aconite is indigenous in Germany, France, and Switzerland, and 
is cultivated as a garden plant all over Europe and America. The 
root is so strikingly like that of horseradish as to be readily confused 
with that article of food, but does not emit the pungent fumes of the 
latter when it is scraped or broken. It is to be remembered, however, 
that it produces a distinct feeling of heat in the mouth when chewed. 
The active principle upon which the therapeutical value of aconite 
would appear to depend is aconitine, but there is reasonable doubt 
whether this can be relied upon as completely as the fluid prepara- 
tions of the crude drug ; the aconitine of commerce, moreover, varies 
very much in strength, because some of it is amorphous and impure, 
while other samples are very pure and crystalline. Further than this, 
even the crystalline form is exceedingly variable. In addition to 
aconitine Dunstan asserts that there are two amorphous alkaloids — 
namely, aconine and napelline, and this investigator believes that there 
is a fourth alkaloid closely allied to napelline. 

Physiological Action. Nervous System. — Aconite in full medi- 
cinal dose depresses the functional activity of the perceptive centres in 
the brain, the sensory side of the spinal cord, and, finally, the peripheral 
ends of the sensory nerves. Applied to a mucous membrane, it acts 
as a local anaesthetic, but is too irritating for use in the eye. On the 
motor portion of the body it exerts little influence, unless given in 
poisonous doses, when it paralyzes the motor tract of the spinal cord 
and the peripheral motor nerves. 

Circulatory System. — On the heart aconite acts, when given in 
moderate doses, as a quieter of its movements and force, and lowers 
blood -pressure and pulse-rate by a direct action on the heart muscle. 
There is no good experimental evidence of its possessing any direct 
influence on the vasomotor system, but clinically it seems to possess 
this power. In poisonous dose it causes first a very marked fall in 
pulse-rate, preceded sometimes by a quickening due to a condition of 
weakness and abortive cardiac action ; this condition gradually passes 
into diastolic arrest of the heart -beat, the viscus becoming paralyzed 
and refusing to respond to stimuli. 

Respiration. — In moderate doses aconite quiets the respiratory 
movements slightly, particularly if the breathing is hurried before 
its use. In poisonous doses it paralyzes the respiratory centres, and 
so causes death. 

Temperature. — Aconite acts as a distinct reducer of fever, prob- 



46 DRUGS. 

ably because of increased heat-radiation arising from relaxation of the 
capillaries and impaired circulation. 

Kidneys. — Ju fever aconite usually increases the urinary flow. 

Poisoning. — When aconite is taken internally in excessive amount 
it causes tingling of the mucous membranes wherever it touches 
them, which sensation finally amounts to severe burning. This soon 
passes away, and is followed by a sense of tingling about the lips and 
finger-tips, or all over the skin. At the same time the patient feels 
relaxed, the pulse becomes slow and weaker, but later on rapid and 
running so that it seems a mere trickle under the finger ; sweating 
more or less severe is present, aud fainting may ensue. Vomiting 
may occur, but is rare. The respirations now become slow and 
shallow, seeming to expand the lung in the smallest possible degree. 
The face is pallid and anxious. There may be exophthalmus, or 
the eyes may be sunken and dull. There is excessive pallor. 
Epileptiform convulsions may be present, due to disorder of the 
circulation at the base of the brain. Previous to this there may be 
marked ansesthesia of the skin. The pupils may be normal, or 
dilated to a wide degree. The sclerotic coat of the eye is pale and 
pearly-looking. The temperature is very low. Death may be gradual 
or sudden, the slightest movement of the body which can throw any 
strain on the heart stopping that organ in diastole. 

Treatment of Poisoning. — The patient is to be placed in a 
prone position or on a board, with the feet higher than the head, in 
order to confine the circulation as far as possible to the vital centres at 
the base of the brain. Hot bottles or bricks are to be placed about the 
body for the purpose of maintaining the bodily heat. Emetics are 
not to be given if the symptoms are severe, as vomiting may cause 
cardiac arrest, owing to the muscular effort involved, or the stomach 
may be so depressed that the emetics will not act. If vomiting comes 
on, let it be into a towel without the patient being allowed to raise the 
head. The stomach is to be washed out by means of a stomach -purnp 
or a siphon made of rubber tubing. Ether may be given hypocler- 
mically, and followed by alcohol, and this again by digitalis. The 
ether acts at once and lasts while the alcohol is being absorbed, and 
the alcohol supports the heart until the digitalis, which is the physio- 
logical antagonist of aconite, but slow and prolonged in its effects, 
asserts itself. If the breathing fails, artificial respiration is to be 
employed, or if the heart seems about to cease its action, a whiff of the 
nitrite of amyl may start it going again, but only a few drops of the 
nitrite should be used, as large amounts depress this organ. Full 
hypodermic doses of strychnine, such as -^ to y^- of a grain, may be 
given to stimulate the respiration and heart. 

Therapeutics, — The employment of aconite in disease is one of the 
most universally recognized procedures in medicine. It fulfils indi- 
cations which nothing else can, and lends itself to the control of a 
large number of morbid processes, its effect being uniformly explain- 
able by its known physiological action. It is used chiefly for its influ- 
ence as a cardiac and circulatory quieter, for its effects on the periph- 



ADONIS VERNALIS. 47 

eral sensory nervous system, as in the vomiting of pregnancy, and in 
those states in which, through inflammation elsewhere, the nervous 
system needs a sedative which will simultaneously reduce arterial ten- 
sion. In the early stages of all acute inflammations aconite is of service. 
It may be applied locally over superficial nerves in neuralgia in the 
form of an ointment (2 grains to 1 drachm, or as the oleate of aconi- 
tine, 2 grains of the oleate to 100 of sweet oil). In the earliest stages 
of gonorrhoea aconite in small doses frequently repeated is a most 
valuable remedy, and later in the disease tends to prevent chordee by 
its influence on the nervous centres. It is useful in croup, quinsy, 
sore-throat, severe colds, bronchitis and asthma due to exposure, in their 
early stages. When suppression of menstruation follows an exposure 
to cold, this drug will often restore the normal flow. In pericarditis 
it is valuable to allay the inflammation and quiet the excited heart, 
and it is also of great value in the earliest stages of pneumonia. It 
ought not to be used in adynamic, asthenic affections. Aconite is use- 
less and harmful in prolonged acute diseases, such as scarlet fever, if 
constantly employed. 

In persons who suffer from asthma which is preceded by coryza, 
aconite does good in the earliest stages. 

In nervous palpitation of the heart, and in the palpitation of exces- 
sive cardiac hypertrophy, it is very valuable. In the epistaxis of full- 
blooded people it often affords great relief. Aconite is by far the best 
circulatory and nervous depressant for children suffering from sthenic 
fevers, particularly of the irritative type. 

Administration. — As a general rule, small divided doses of the 
drug in the form of the tincture, J to J a drop given every fifteen 
minutes, will act better than a full dose given at once, unless the con- 
dition of the patient requires very active treatment. 

Preparations. — Tincture of aconite {Tinctura Aconiti, U. S. and 
B. P.) is used in the dose of 1 to 5 drops in water, repeated every 
hour if needed so often. A very useful way of employing it is in the 
form of tablet triturates. The extract of aconite {JExtractum Aconiti, 
U. S.) is given in the dose of £ to j- of a grain, while of the abstract 
{Abstr actum Aconiti, U. S.) 1 grain is used. The fluid extract {JEx- 
tr actum Aconiti Fluidum, TJ. S.) is given in the dose of 1 to 2 minims. 
Fleming's tincture ought never to be used. The active principle 
aconitine is not official in the U. S. P. Its dose is -j^g- to y^ of a 
grain, but it ought never to be used internally. The JB. P. prepara- 
tions that are not official in the U. S. P. are : aconite leaves [Aconiti 
Folia), aconitine (Aconitina), aconite ointment ( Unguentum Aconitino3), 
and aconite liniment (Linimentum Aconiti). The dose of the extract of 
aconite {JExtractum Aconiti, B. P.), is J to 1 grain. 



ADONIS VERNALIS. 

From Adonis vernalis, a plant indigenous in Europe and Asia, is 
derived a glucoside, Adonidin. When given to one of the mammalia 



48 DRUGS. 

— the dog, for instance — it causes an increase in heart force and a rise 
of arterial pressure. In the frog, poisonous amounts arrest the heart 
in diastole. 

The indications for the use of adonis are all conditions of cardiac 
failure, particularly the presence of cardiac dropsy. It is much infe- 
rior tl> digitalis and caffeine, but may be employed when these fail, as 
it sometimes succeeds under such circumstances. The dose of adonidin 
is J to J of a grain three times a day ; or, 4 to 8 parts of the plant — all 
portions of which are employed — may be added to 180 parts of water, 
and of this infusion a tablespoonful may be given every four hours. 



AGARIOIN. 

- Agaric, or Touchwood, or Punk, has been used in the southern 
United States very largely in the dose of 5 grains every few hours 
in the treatment of the night-sweats of phthisis ; and agaricin, the 
alcoholic extract of the drug, has been used with very extraordinary 
results, under these circumstances, by certain German and English 
physicians, in the dose of from 1 to 2 grains every five hours. Its 
physiological action is unknown, but it is supposed to act upon the 
nerve filaments in the sweat-glands. The writer has employed it fre- 
quently in varying dose, and has never seen any decrease whatever 
produced by it in the sweats of phthisis, although he has watched it 
most closely, expecting to see great relief follow its use. 



ALCOHOL. 

Ethyl alcohol (Alcohol JEthylicum, B. P.) is the only alcohol used 
in medicine. Some of the other alcohols are exceedingly poisonous. 
Amy lie alcohol is fusel oil. 

Alcohol is a liquid derived from the fermentation of starches or 
sugars in the presence of heat. It is official in two forms — namely, 
as Alcohol, U. $., containing 91 per cent, of the spirit and H per cent, 
water, and Alcohol Dilutwm, U. S., or dilute alcohol, 45.5 per cent, 
spirit and the remainder water. The drug is generally given in the 
form of whiskey or brandy, and when the word alcohol is used in the 
saying, " Give the patient alcohol," one of these two liquids is always 
meant unless it is otherwise stated. 

Physiological Action. Nervous System. — Alcohol acts first as a 
powerful excitant and afterward as a most active depressant and 
paralyzant of the nervous system. Locally applied in small amounts 
to the peripheral nerves it excites them at first and paralyzes them 
afterward. By the primary stimulation of the brain it increases the 
rapidity, but not the depth, of thought, while it increases the reflex 
activity of the spinal cord, the muscles, and the nerves. In large 
doses it produces lack of coordination by depression of the brain and 
lower nervous system, the loss of coordination being due largely to 



ALCOHOL. 49 

sensory paralysis, so that the power of touch is interfered with. This 
makes a drunken man fail to recognize the angles and surfaces of 
obstructions, and the impaired mental power and disordered judgment, 
combined with the badly acting motor and sensory pathways, cause 
him to stumble and fall. 

Circulatory System. — When alcohol is ingested, either by man 
or the lower animals, it stimulates the heart muscle and increases the 
rapidity as well as the force of its beat. According to Dogiel, the 
increase in rate is partly due to stimulation of the accelerator nerves, 
but Castillo denies any such influence. Wood teaches that the effect 
of alcohol is not through any action upon these nerves, and is proba- 
bly correct in his belief. Along with the stimulation of the heart a 
rise of arterial pressure ensues, largely due to increased heart action 
and partly to vasomotor stimulation. In very large toxic doses alcohol 
depresses and finally paralyzes the heart and vasomotor system as well 
as the nervous system. 

Respiration. — Respiration is stimulated by small doses of alcohol 
and decreased by large ones. 

Temperature. — Alcohol at no time increases to any extent the 
actual number of heat units in the body. It produces a sensation of 
warmth and warms the extremities by causing the heart to pump hot 
blood from the centre of the body to the cold parts. If it be used in 
excess the temperature rapidly falls, owing primarily to the increase 
of heat- radiation produced by the excessive distribution of heat just 
named, and secondarily by the depression of vital power which is 
caused by a too rapid destruction of the tissues of the body in the 
effort induced by the drug. Calori metrical studies show that, while 
more heat may be created under its influence, so much heat is dissi- 
pated that the temperature nevertheless falls. 

Bodily Metabolism. — The quantity of carbonic acid given off by 
the body, under the use of alcohol, is in most instances increased ; but 
it may be decreased. The effect on the absorption of oxygen is not 
known. Some observers have noted an increase, some a decrease of 
such absorption, and some no change at all, when alcohol is taken. 
Upon the giving off of nitrogenous substances it acts as a decided 
depressant, which seems to prove that it inhibits rapid tissue changes, 
and is a conservator of vital power. It adds force, but not tissue, to 
the body. 

Elimination. — Alcohol is largely " burnt up" in the body, but 
when taken in excess of the latter's oxidizing power, it is eliminated 
by the breath, and by the skin, kidneys, and intestines. 

Digestion. — Alcohol added in auy amount to food in a test-tube 
containing digestive ferments retards or inhibits digestion, but in the 
stomach, on the other hand, it assists the process ; for, by reason of its 
irritant and stimulating properties, it induces the secretion of an excess 
of the digestive juice. 

Therapeutics. — The employment of alcohol in disease can here be 
only briefly alluded to, special mention of its indications being named 
where the diseases in which it is used are discussed. Its chief uses 



50 DRUGS. 

are as a rapidly acting stimulant in all forms of cardiac failure due to 
shock or to poisons, and as a systemic support and stimulant in low 
fevers and prolonged wasting diseases, in old age, and in convalescence 
from acute disease. 

Some of the conditions, to state them specifically, in which alcohol 
is indicated, are fainting, snake-bite, surgical shock, acute, subacute and 
chronic pneumonia in its later stages, and excessive wasting, due to 
prolonged suppuration. 

Alcohol should never be given in sthenic fevers unless some com- 
plication, such as syncope or pneumonia, comes on. The reason 
it is contra-indicated is that in sthenic fevers the circulation is already 
sufficiently excited, and is generally in excess of the needs of the 
system. In exhausting fevers, such as typhoid or typhus, alcohol finds 
its true usefulness. While it is well to give alcohol in many cases 
from the beginning to the end of the attack, for the double purpose of 
aiding digestion and of supporting the system, its administration should 
not be a mere matter of routine, but should be based upon clear ideas 
of the indications it is calculated to fulfil. If the pulse is weak and the 
patient seems to be sinking, or the appetite is failing and adynamia 
is a pressing symptom, alcohol is indicated ; but if the pulse is good, 
and the passage of the patient through his illness is not a stormy one, 
alcohol should be excluded from the sick-room. In phthisis, in neu- 
ralgia, and in similar states dependent upon depression of the system, 
care must be taken to prevent the setting up of a " habit." 

Alcohol is very useful as a local application to ulcers and wounds, 
as it acts as an antiseptic and stimulant, and when combined with salt 
forms a useful liniment in cases of debility and atony of the skin and 
subcutaneous tissues. 

Acute Poisoning. — In advanced poisoning by alcohol, with coma and 
total relaxation, external heat and hypodermic injections of digitalis 
and strychnine are indicated, if the heart or respiration seems failing. 
Belladonna should be administered to stimulate the vasomotor system 
if the skin is relaxed and clammy, and counter-irritation to the back 
of the neck is to be employed if any brain symptoms seem pressing. 
The after-treatment consists in the use of substances stimulating to the 
stomach, such as ammonia, spirit of Mindererus, and spices, unless 
there is gastric inflammation, when emollient substances should be used 
to quiet the irritation. If persistent vomiting comes on it must be 
quieted by the patient swallowing pieces of ice, by aconite, cocaine, or 
minute doses of ipecac. Counter- irritation should be applied over the 
belly. If the emunctories are not acting freely, thorough purgation 
by jalap or elaterium (40 grains of jalap powder or jr of a grain of 
elaterium) should be employed ; or calomel followed by a saline may 
be given, if milder effects are sought. 

In view of the frequency with which alcoholic and opium poisoning 
are confused, the following table is appended, which will be found 
of value in making a differential diagnosis as to the conditiou of the 
patient : 



ALCOHOL. 51 



Alcoholism and Opium Poisoning. 

Alcoholism. Opium Poisoning. 

1. Pupils normal or dilated. 1. Pupils contracted. 

2. Kespiration nearly normal. Pulse 2. Eespiration and pulse slow and full, 
rapid, and finally feeble. 3. Face suffused and cyanosed. 

3. Face may be pallid. 4 Skin warmer than in alcoholic 

4. Skin cool, perhaps moist. poisoning 

Note. — The urine is always to be saved 
for medico -legal examination. 

There is scarcely any difference as to consciousness in the two conditions. 
Acute Alcoholism and Apoplexy. 

Alcoholism. Apoplexy. 

1. Pulse rapid, compressible, and 1. Pulse apt to be strong and slow, 
weak. 

2. Skin moist, or relaxed and cool. 2. Skin hot or dry. 

3. Bodily temperature lower. 3. Bodily temperature raised. 

4. Pupils equally contracted or di- 4. Pupils unequal, 
lated ; generally dilated. 

5. No hemiplegia. 5. Hemiplegia; one side tossed, the 

other remaining motionless 

6. Breathing not so stertorous, nor so 6. Eespiration stertorous ; the lips 
one-sided in lips. being inflated on one side on expiration. 

7. No facial palsy. 7. Facial palsy. 

8. Unconsciousness may not be com- 8. Unconsciousness complete, 
plete. 

The smell of alcohol in the breath is no guide, as acute alcoholism may have caused 
the rupture of a cerebral bloodvessel. 

Chronic Poisoning". — The treatment of this condition may be car- 
ried out in two ways : First, by the isolation of the patient and the 
complete withdrawal of the drug at once ; secondly, by what is better, 
a gradual tapering-off in the daily amount of the spirit. In either 
instance isolation must be absolute, and all smuggling of alcohol to or 
by the patient prevented. The attendants must be absolutely trust- 
worthy. Careful scrutiny of bed-clothes and closets will often be re- 
warded by finding hidden bottles. The depression of the patient when 
recovering from alcoholism must be met by the use of nutritious broths 
highly seasoned, in order to stimulate the stomach, by easily digested 
or predigested foods, and by small doses of morphine or coca if the 
patient be very weak and need such a stimulus. Koumyss is an ex- 
ceedingly valuable preparation under these circumstances. 

In the treatment of the atonic stomach of drunkards nothing does 
so well as the following pill : 

R. — Oleoresin. capsici Ttlx. 

Olei caryophylli Mix. 

Hydrarg chlor. mit gr. xx. 

Aloe Socotrinse gr. xl. M. 

Ft. in pil. no. xx. S. — One three times a day after or before meals. 

If this pill fails to move the bowels after thirty-six hours, a saline 
purgative should be used to avoid any danger of rnercurialism. 

(See Capsicum.) 



52 DRUGS. 

Chronic alcoholism may produce cirrhosis of the liver, with the 
resulting symptoms, notably ascites. 

The following are the principal points in the differential diagnosis of 

Alcoholism and the General Paralysis of the Insane. 

Alcoholism. Paretic Dementia. 

1. Attacks shorter, and more widely 1. Attacks more prolonged, 
separated by intervals of sanity. 

2. Delirium may be of any character. 2. Delirium of grandeur more marked 

and denned. 

3. Visions more characteristic, and are 3. Visions often not evil, but pleasant, 
evil. 

4. Tremors confined to head and arms. 4. Tremors more diffused. 

5. Tremors removed by dose of alco- 5. Tremors made worse by alcohol, 
hoi. 

6. Mental symptoms temporarily re- 6. Mental state made worse by alcohol, 
moved, or at any rate improved, by 

alcohol. 

7. Tremors occur chiefly in the morn- 7. Tremors not confined to the morn- 
ing, ing. 

There is danger of pneumonia from failure of the right side of the 
heart in subacute and chronic alcoholism, and the physician should 
always be on the lookout for this complication. 

Administration. — Brandy and whiskey are generally used as rapidly 
acting stimulants. They should be exhibited in the form best adapted 
to the work they are intended to perform. If the action must be in- 
stantaneous, as in a case of fainting, they should be employed hot and 
concentrated, so that the stomach has not to warm the liquid before 
absorption. They are to be used hypodermically if still more rapid 
action is required. If administered to aid digestion and support the 
system, then they should always be given with the food — never alone, 
and never concentrated. They may be given as milk-punch or as egg- 
nog, the latter being the " heavier " of the two so far as digestion is 
concerned. Wine-whey is very light and useful. Mulled wine and 
champagne are particularly useful in the treatment of irritable stomach. 
(For recipes for mulled wine and wine-whey see Foods for the Sick.) 
The champagne should always be as devoid of sugar as possible — that 
is, what is known as " extra dry/' Gin is rarely employed as a stim- 
ulant, except when given to young children, or to adults, when the 
kidneys are torpid. Stout and porter are of value in wasting diseases, 
in convalescence from acute diseases, and for nursing women. Lager 
beer contains too little alcohol to be used as a distinct stimulant, but 
may be used in moderation to aid digestion, or ale may be employed 
instead. Clarets are useful aids to digestion, and port is also of value 
in these cases. 

Contra-indications. — All states of cerebral excitement, unless due to 
exhaustion, acute inflammations, the alcoholic habit, apoplexy, menin- 
gitis, acute nephritis, aneurism, and advanced atheroma contra-indicate 
the use of alcohol. 

The official preparations of alcohol are as follows : 



ALLIUM. 53 

Whiskey (Spiritus Frumenti, U. S.) should be at least three years 
old, and be made, in America, from rye for medicinal purposes. 

Brandy (Spiritus Vini Gallici, U. S. and B. P.) is obtained by the dis- 
tillation of fermented grapes or fruits, and should be from three to five 
years old before use. 

Cologne Water (Spiritus Odoratus, U. S.) is used solely as a lotion and 
perfume. 

Red Wine ( Vinum Bubrum, U. S.) is made from grapes not deprived 
of their skins. White Wine ( Vinum Album, U. S.) is the fermented 
juice of grapes the skins of which have been removed. 

Dilute (Alcohol Dilutum, U. S.), and pure alcohol (Alcohol, U. S.), are 
also official. 

The unofficial preparations are : 

Rum, which is made from the fermentation of molasses, and con- 
tains about 40 to 45 per cent, of alcohol. 

Gin is made from rye or barley, with the addition of juniper berries 
and hops. (Good gin and the Spiritus Juniperi Compositus of the 
U. S. Pharmacopoeia are virtually identical therapeutically). When 
diuresis is required and atony of the kidneys is present, without in- 
flammation, gin is a useful medicament, provided that a stimulant is 
indicated. Gin is one of the alcoholic drinks most apt to produce 
cirrhosis of the liver. 

Port Wine ( Vinum Portense, B. P.) is a fermented wine to which 
pure spirit is added to increase its strength. It is one of the strongest 
table wines, and is useful as a stimulant in convalescence. 

Sherry ( Vinum Xericum, B. P.) has about 30 per cent, of alcohol in 
it. It is not official in the U. S. P. 

Beer is made by a slow fermentation, while Ale is made by a more 
rapid fermentation at a higher heat. 

Porter resembles the other malt liquors closely, except that it con- 
tains more solids, due to a scorching of the grain by a high heat. 

The B. P. preparations that are not official in the U. S. P. are rec- 
tified spirit (Spiritus Rectificatus), proof spirit (Spiritus Tenuior), sherry 
( Vinum Xericum), amylic alcohol (Alcohol Amylicum), and Mistura 
Spiritus Vini Gallici, which is a useful, pleasant and nutritive stimu- 
lant made by beating up the yolks of two eggs with half an ounce of 
sugar, and then adding four ounces each of brandy and cinnamon- 
water. This is sometimes called " egg-flip/ 7 



ALLIUM. 

Garlic is a stimulant to digestion, owing to the volatile oil it con- 
tains, which, by its somewhat irritating qualities, excites the gastric 
mucous membrane to increased secretion. In persistent colds, where 
the bronchial tubes are particularly affected, a garlic poultice, made by 
pounding the bulbs in a mortar, is a very efficient, though disagree- 
able, remedy. In the treatment of children with colds, garlic may be 
used boiled in milk, and the liquid given as a drink, warm or cold, or 



54 DRUGS. 

the oil of garlic may be given in emulsion in the dose of 1 or 2 drops. 
It ought not to be given during the febrile stage, as it is stimulating. 
If the skin in any case is too delicate to permit of the use of pounded 
garlic alone, it may be mixed with equal parts of bran, and a regular 
poultice or plaster made thereof. Employed in this form, allium is 
useful if applied over the spine or feet in the treatment of the cerebral 
and spinal convulsions of infants ; placed over the belly in cases of 
g astro-intestinal catarrh, it acts almost as well as a spice poultice. 
Allium-juice has also been used, in the dose of 2 to 5 drops, to relieve 
nervous vomiting. The dose of the syrup (JSyrupus Alii, TJ. S.) for a 
child is 1 drachm, but 4 drachms may be given to an adult. 



ALMONDS. 

Almonds are official in the form of the bitter almonds (Amygdala 
Amara, U. 8. and B. P.), and the sweet almonds (Amygdala Dulcis, 
U. S. and B. P.). Bitter almonds develop hydrocyanic acid in the 
presence of water, by the reaction between the amygdalin and water 
in the presence of the emulsin contained in them ; this is not the case 
with sweet almonds. 

Sweet almonds, when rubbed up in a mortar with water, form a 
pleasant-tasting emulsion of an agreeable odor, that is very useful as a 
vehicle for remedies having a disagreeable taste. Almond bread has 
been proposed as a food for diabetics, owing to its containing virtually 
no starch ; but it is requisite that the oils and saccharine constituents 
of the almond shall first be removed. (See Foods for the Sick.) 

When half an ounce of sweet almonds are rubbed up with thirty 
grains of gum arabic and two drachms ot sugar, to w T hiclr is added 
gradually a half-pint of distilled water, the mixture being then strained, 
an emollient and soothing drink is formed which is very useful in 
irritations of the stomach and intestines, and of the air-passages and 
pharynx. The expressed or essential oil of almonds is a useful demul- 
cent, and has been recommended in the cough of phthisis, given in the 
dose of a few drops in emulsion. 

Bitter almonds give off an oil ( Oleum Amygdalce Amarai, U. S.), which 
is exceedingly poisonous, owing to the prussic acid which it contains, 
and it is said that one drop will kill a cat, while seventeen drops have 
killed a man. 

Bitter almonds are used to allay irritable coughs and similar states, 
but are not frequently employed, because other drugs are less danger- 
ous, more stable, and more active as remedial agents. The emulsion 
of bitter almonds is made as is that of sweet almonds, and may be used 
in teaspoonful doses for the same purposes, and as a vehicle in cough 
mixtures. Both emulsions are useful as vehicles in the treatment of 
gonorrhoea, to diminish the burning on urination. Almond emulsions, 
when locally applied, are supposed to be of value for the removal of 
freckles and sunburn. 

The preparations of sweet almonds are : a mixture (Mistura Amyg- 



ALOES, 55 

dalce, U. S. and B. P.), dose 1 to 2 ounces ; a syrup {Syrupus Amyg- 
dalae } U. S.), dose 2 drachms to 2 ounces ; a compound powder {Pulvis 
AmygdaloB Compositus, B. P.), given in the dose of 1 to 2 drachms ; 
and the oil {Oleum Amygdalae PJxpressum, U. S. and B. P.), the dose 
of which is 1 to 4 drachms. Aqua Amygdalae Amaroe { U. S.) is pre- 
pared from the oil of bitter almonds. The dose is 30 to 60 drops. 



ALLSPICE. 

Allspice, or Pimenta {U. S. and B. P.), is the nearly ripe fruit of 
Eugenia Pimenta, a tree of the West Indies. It contains an official 
volatile oil {Oleum Pimentos, U. S. and B. P.), used for flavoring pur- 
poses, as a constituent of spice plasters, in diarrhoea mixtures, or as a 
carminative. It will also prevent the griping of purgative medicines. 
The dose of the oil is 1 to 5 drops. Aqua Pimentos {B. P.) is given in 
the dose of 1 to 2 ounces. 

ALOES. 

Aloes, or Aloe of the U. S. P., is derived solely from the Aloe 
Socotrina, while that of the B. P. is obtained not only from Socotrine 
aloes, but also from Barbadoes aloes {Aloe Barbadensis, B. P.). It is 
the inspissated or dried juice of the leaves of the plant. The actual 
species from which the drug is derived is uncertain. It is probably 
derived from several species. Aloes contains an active principle known 
as alo'in, which is a crystalline substance. As alo'in is generally sold, 
it is, however, an amorphous powder of extremely bitter taste. 

Physiological Action. — Locally applied to the tongue, aloes is a 
bitter of rather a persistent taste. According to the studies of Ruther- 
ford, the drug increases very considerably the now of bile in the dog, 
but in man it cannot in any sense be regarded as a medicament for the 
production of an increased biliary flow. Rutherford's doses given to 
the dog amounted to as much as sixty grains, equal to three or four 
drachms in man. In the lower animals and in man aloes acts very 
slowly, requiring many hours for its influence to be distinctly felt, 
unless the dose be toxic in amount. As much as four drachms of 
aloes have been injected into the veins of a horse without inducing 
purgation, probably because four drachms were not enough to affect 
the bowels. Aloes has been used endermically, and when so employed 
is said to act thoroughly. It is eliminated by the milk of nursing 
women, and will cause purgation in an infant put to the breast of a 
patient taking it. If the doses be quite large (10 to 20 grains), the 
passages will be watery ; but if the dose be more moderate (2 to 3 
grains), the stools will be thick and pultaceous. 

Therapeutics. — Aloes should be used only when a somewhat slow 
stimulant to peristaltic movement is desired, and never where the 
object of the physician is to relieve congestions by depletion through 
the intestine. It is a favorite remedy in cases of subacute or chronic 



56 DRUGS. 

constipation, but is distinctly harmful if continued constantly for any 
length of time, as it seems to produce atony of the bowel. Owing 
to its bitter properties it acts as a tonic to the stomach, and is often 
given with iron to promote the absorption of this metal by stimulat- 
ing the liver and by preventing any constipation which might be 
produced by the chalybeate. 

When taken in a large enough dose to produce a copious passage, 
aloes nearly always produces a feeling of weight and fuluess in the 
region of the rectum after the evacuation, and the writer has seen 
severe rectal catarrh produced in this way. If given alone it is very 
apt to produce griping, and it ought always to be combiued with 
other drugs whose tendency is to prevent intestinal spasm. 

In cases of hcemorrhoids occurring in persons suffering from general 
muscular relaxation and atony, aloes is said to do great good, but its 
use under these circumstances is by no means universal or generally 
accepted as correct. For weak, anaemic persons, leading sedentary 
lives, it may be combined with tonics to relieve the constipation so 
often a pressing symptom in these cases. In amenorrhcea dependent 
upon atony of the sexual system, or anaemia, or constipation, it is 
thought to have a specific emmenagogue influence. Locally applied in 
the form of the glycerole of aloes, it has been employed in the heal- 
ing of old or new fissures of mucous membranes, and even in bedsores. 
The glycerole of aloes is to be made by evaporating four to eight 
quarts of tincture of aloes and gradually adding thirty parts of glycerin. 

Contra-indications. — Constipation occurring in plethoric persons 
should not be treated by aloes, and it should not be used if any irri- 
tation or catarrh of the intestine is present. Pregnant women should 
use aloes most carefully lest abortion be produced, and if hepatic con- 
gestion or inflammation is present it ought not to be used. Fever is 
said to contra-indicate the use of aloes, as does rectal catarrh. 

Administration. — Aloes is generally given in a pill, combined with 
spices and belladonna (see Constipation, Part IV.). The dose should 
be about 1 to 5 grains as a laxative, and 10 grains as a purge. The 
Aloe Purificata, U. 8. P., should always be used. The official prepa- 
rations most commonly employed are the pill of aloes (Pilulce Aloes, 
U. S. and B. P.), two grains each of aloes and soap ; the pill of aloes 
and myrrh (Pilulce Aloes et Myrrhce, U. 8. and B. P.), two grains of 
each constituent ; the pill of aloes and mastisch {Pilulce Aloes et 3fas- 
tiches, U. 8., two grains of aloes), or the " Lady Webster dinner pill ;" 
the pill of aloes and iron (Pilulce Aloes et Ferri, U. 8. and B. P.), 
one grain of aloes and one of dried sulphate of iron ; and the pill of 
aloes and asafoetida (Pilulce Aloes et Asafcetidw, U. 8. and B. P.), 
containing four grains of aloes, asafoetida, and soap. The dose of all 
these is 1 to 2 pills. The liquid preparations are the tincture (Tine- 
tura Aloes, U. 8. and B. P.), dose 1 to 3 fluidrarhms ; the tincture 
of aloes and myrrh (Tinctura Aloes et Myrrhce, U. 8.), dose 1 to 2 
fluidrachms ; l and the wine of aloes ( Vinum Aloes, U. 8. and B. P.), 

1 Sometimes called Elixir Proprietatis. 



ALUM. 57 

containing cardamoms and ginger, the dose of which is J to 1 drachm 
or even 2 drachms. The B. P. preparations, besides those given, are 
Aloin, dose J to 2 grains ; the Decoctum Aloes Composition, dose ^ to 
2 ounces ; and the extract, Mctractum Aloes Socotrince and the Extrac- 
tum Aloes Barbadensis, the dose of each of which is 2 to 6 grains. 
Enema Aloes, given in the dose of 10 ounces, is composed of aloes 40 
grains, carbonate of potassium 15 grains, and mucilage of starch 10 
fluidounces. 

ALUM. 

Alum {Alumen, U. S. and B. P.) is the sulphate of aluminium and 
potassium, or of aluminium and ammonium, crystallized from a 
watery solution. At present all the alum of commerce is made in 
the manufacture of coal gas for illuminating purposes, and it is there- 
fore very cheap. It occurs in the form of octahedral crystals, and has 
an astringent taste and acid reaction. After the crystals are exposed 
to the air for some time they become covered with a white coating. 

Physiological Action. — When alum is brought in contact with a 
mucous membrane it produces whitening, constriction, and puckering 
of the part, and applied to the skin thickens and toughens it by means 
of its astringent action. In either case it decreases secretion and 
causes contraction of the local bloodvessels and capillaries. Large 
amounts given for any. length of time seem to increase secretion. Very 
large amounts are necessary to produce death. As much as two ounces 
will not kill a sickly dog. This is largely due to the fact that the 
vomiting and purging rids the animal of the drug, for if vomiting is 
prevented death rapidly ensues from gastro-enteritis. Injected into 
the blood, alum produces embolism and thrombosis. 

Therapeutics. — Alum is used at present in a number of diseases, 
chiefly as a local application. In cases of ordinary sore-throat appli- 
cations of a strong solution (20 grains to the ounce of water) on a 
swab will be found very useful. It is a valuable gargle in this con- 
dition, but ought not to be used because of its destructive action on 
the teeth. In hemorrhage, when the leaking bloodvessels can be 
directly reached, alum is a remarkable haemostatic, aiding in the 
arrest of the bleeding in three ways, namely, by coagulating the 
albumin, by constringing the parts, and by crystallizing when applied 
in large amounts on lint, and thereby affording a surface which is 
rough and aids coagulation. In hemorrhage after tooth-extraction 
its application is a very useful treatment. Dissolved in water, or 
alcohol, it makes an exceedingly efficient application for sponging in 
night-sweats or localized sweating of the feet or hands. In conjuncti- 
vitis as a lotion alum may be employed in a solution of 1 to 3 grains 
to the ounce of water for a child, or in the form of alum curd, made 
by adding powdered alum to milk or white of egg until a curd is 
formed, which is then applied to the eye every few hours or oftener. 
This is often useful in ecchymosis of the eyelid, or "black-eye," to 
prevent much exudation and discoloration. In cases where granular 



58 DRUGS. 

conjunctivitis occurs, the use of the alum crystal or stick is sometimes 
very useful, the lid being lifted and the alum passed lightly over it. 
In haemoptysis sl fine spray of a strong solution of alum, 20 grains to 
the ounce, may be employed, the necessity of the spray being made 
very fine being constantly borne in mind. This method may also be 
resorted to in bronchorrhcea or chronic bronchitis with excessive secre- 
tion, and in chronic catarrh of the pharynx and larynx. In mercurial 
ptyalism the drug may be used on a swab. Bathing the parts affected 
with an alum solution is said to be an efficient remedy in chilblains, 
and even for pruritus vulvas. As a vaginal wash for .excessive leucor- 
rhcea, in the strength of from 10 to 20 grains to the ounce of water 
alum is of value. Some observers claim good results from its use in 
diphtheria and tonsillitis, in follicular tonsillitis the alum-stick may 
be deeply inserted into the depressed follicles or applied to the swollen 
surface of the gland. In ingrowing toe-nail with granulations, a piece 
of twisted absorbent cotton soaked in strong alum solution and in- 
serted under the edge of the nail, will in most instances do a great 
deal toward a cure. Burnt Alum (Alum Exsiccatum, U. S. and B. P.) 
is useful as a dressing for old ulcers and sores, and has been highly 
recommended as an application for swollen gums where they press upon 
and override a tooth, particularly at the back of the jaw. The possi- 
bility of its exercising an evil effect on the teeth should not be forgotten 
when this treatment is resorted to. 

Internally, alum has been used in diabetes, gastralgia, and dysentery 
of an acute and chronic type. In lead-colic it seems to be of value 
in conjunction with morphine to allay the pain. In some forms of 
constipation it is said to be quite valuable if given in large dose. At 
one time alum was largely employed in membranous croup in emetic 
dose for the dislodging of the membrane and for the astringent effect 
exercised as it was swallowed and expelled. 

Alum may be used as an antidote in acute lead-poisoning, as it is a 
soluble sulphate and also an emetic. 

The emetic dose of powdered alum is a heaping teaspoonful for a 
child or a tablespoonful for an adult. 

Glycerinum Aluminis (1 to 5) is official in the B. P., and is used 
as a local astringent application. 



AMBER. 

Succinum is derived from a fossil resin found in Prussia and Bohe- 
mia, and is official in the form of the oil (Oleum Succini, U. 8.), which 
is volatile, quite irritant, and obtained by destructive distillation from 
the deposits named. 

Therapeutics. — Oil of Amber is one of the best remedies for per- 
sistent hiccough that we have. It is very useful as a counter-irritant 
over rheumatic joints, and has been used in asthma, whooping-cough, 
and hysteria with good results. In the bronchitis of infants, with 
nervous disturbance, oil of amber in the proportion of one to three 



AMMONIA. 59 

parts of olive oil applied to the back and front of the chest is of 
service. In adults suffering from acute laryngitis with an extension 
of the inflammation into the bronchial tubes full doses of sodium 
bromide with this proportion of amber oil rubbed into the neck and 
chest are very useful. The dose internally is 2 to 6 minims given in 
emulsion. 

AMMONIA. 

Ammonia is a gas of a very acrid, burning taste and sensation, 
capable of producing death very rapidly, when inhaled, by inflam- 
mation of the air-passages and the spasm of the glottis which ensues. 
It is made in large amounts in the manufacture of coal gas. 

Physiological Action. — When ammonia comes in contact with the 
tissues of the body it acts as a most powerful irritant, causing a red- 
dening of the parts, followed, if the exposure be long enough, by 
local death and sloughing. If it be inhaled as a gas it may produce 
instant death by spasm or oedema of the glottis, or if a strong solu- 
tion of it is swallowed the same accident will occur. After more 
moderate inhalations severe bronchitis or pulmonary oedema may take 
place. 

Nervous System. — If ammonia be injected into the blood of 
animals violent convulsions at once ensue which are largely tetanic in 
type and depend upon a spinal action of the drug, since they are not 
stopped by division of the spinal cord, as they would be if the convul- 
sive movements had their origin in the brain. The drug in moderate 
amounts acts as a spinal excitant, increasing reflex action and all the 
evidences of spinal activity. If applied directly to a nerve, either 
motor or sensory, it paralyzes it, or if the drug be in very weak solu- 
tion it seems to increase its functional activity. 

Circulation. — Upon the circulation ammonia acts as a very power- 
ful but fleeting stimulant, increasing to a very great extent the pulse- 
rate, pulse force, and arterial pressure. The cause of the increased 
pulse-rate depends upon stimulation of the accelerator nerves of the 
heart, and of the heart itself, while the increase in force is due to the 
same cause, for Ringer and Sainsbury found the strength of the ven- 
tricles much increased. The rise of arterial pressure is due to the 
increased amount of blood pumped into the arteries by the stimulated 
heart, and probably by an action on the vasomotor centre, although 
it is stated by some authorities that this is not so. As the drug acts 
as a stimulant on the respiratory centre, which is very near the vaso- 
motor centre, it probably increases the functional activity of both. If 
by means of intravenous injection the ammonia reaches the heart in 
large amount, this organ ceases its beat at once, owing to paralysis of 
its muscular walls. 

The Blood. — In moderate amounts the drug has no effect on the 
blood, but when injected in poisonous quantities it causes the blood to 
fail to take up the oxygen, according to Feltz and Ritter. 

Respiration. — The injection of ammonia in moderate quantities 



60 DRUGS. 

into the blood causes an acceleration of the rate of respiration due to 
a stimulation of the respiratory centre, so that the respiratory move- 
ments not only become more full, but more rapid. If the drug is 
inhaled in small amounts the same action is seen in a less degree, and 
the changes both in breathing and circulation are partly due under 
such circumstances to a reflex irritation transmitted along the sensory 
nerves. 

Elimination. — Ammonia when taken into the body is so extremely 
fleeting in its action that the question as to its escape from the system 
is of interest. If large amounts are taken, it is partly given off by the 
breath, but more of it is burnt up in the system, and, according to 
Bence Jones, eliminated as nitric acid by reason of its being oxidized 
in the body. Some think that it is in part excreted as urea. 

Therapeutics. — Ammonia is employed for four distinct purposes in 
medicine, namely : as a circulatory and respiratory stimulant, as a 
counter-irritant, and as an antacid. 

The indications for the use of ammonia in the first class of cases are 
all forms of sudden cardiac failure, where there is no time or oppor- 
tunity to use the more stable and slowly-acting drugs. These emer- 
gencies occur in snake poisoning, in syncope, from fright or other shock, 
or indigestion, in sudden cardiac failure during the course of fevers 
and in pneumonia, and in all cases where rapid cardiac stimulation is 
needed. In the most pressing cases it should be injected directly into 
the vein of the leg so as to act more quickly. If put into the subcu- 
taneous tissues it is almost certain to make a slough, and if injected 
into a vein of the arm it may reach the heart in too concentrated form 
and cause cardiac depression. Ringer has found that the drug has 
the extraordinary power of causing a heart stopped or depressed by 
chloroform to return to its beating. 

In gastric acidity due to fermentation, with the development of 
abnormal acids, ammonia is the most active remedy we can employ, 
but is not to be given if acute irritation of the stomach exists. 

In prolonged diseases the employment of ammonia is not particu- 
larly advisable, owing to its fugacious action, although it is largely 
used ; for the frequent administration necessarily required is apt to pro- 
duce gastric disorder. Some persons claim that ammonia is useful as 
a sedative in drunkenness, but this is doubtful. 

Locally applied, strong ammonia water may be used to produce a 
blister by placing a few drops on the skin under an inverted watch- 
glass. Ammonia water may also be applied, often with great relief, 
to the spot stung by insects. The waters of ammonia are used exter- 
nally in stimulating liniments, and hypodermically when the drug is so 
given. The stronger water ought not to be employed for the latter 
purpose. The aromatic spirit is generally used internally in the dose 
of J drachm to 1 drachm, well diluted. This is also the dose of the 
ordinary spirit. 

Administration. — Ammonia is never employed in medicine as pure 
ammonia, but in the form of the stronger water ( Aqua Ammonias For- 
tior, U. S. ; Liquor Ammonias Fortior, B. P.) and the weaker water 



BROMIDE OF AMMONIUM. 61 

(Aqua Ammonias, U. S. ; Liquor Ammonice, B. P.). The spirits of 
ammonia (Spiritus Ammonias, U. S.), are given in the dose of 30 to 60 
minims in water ; and the aromatic spirit of ammonia (Spiritus Ammo- 
nias Aromaticus, U. S. and B. P.), in the dose of 25 to 60 minims in 
water. The latter preparation is composed of carbonate of ammonium, 
the oils of pimenta, lemon and lavender, with alcohol and ammonia 
water. Spiritus Ammonias Fostidus and Linimentum Ammonice are 
both official in the B. P. 

AMMONIUM. 

The following salts of ammonium are official, and are used for vari- 
ous purposes : 

Acetate of Ammonium. 

Acetate of Ammonium is used in medicine in the form of the Spirit 
of Mindererus (Liquor Ammonias Acetatis, U. S. and B. P.), dose 1 to 
2 fluidrachms, for the purpose of acting as an antacid in gastric in- 
digestion, and also as a mild diaphoretic, which is inferior to sweet 
spirit of nitre. 

Benzoate of Ammonium. 

Benzoate of Ammonium (Ammonii Benzoas, U. S. and B. P.) is em- 
ployed chiefly for its diuretic influences, which depend entirely upon 
the benzoic acid present in the compound. As benzoic acid is elimi- 
nated as hippuric acid, and ammonia as nitric acid, this drug may be 
employed in cases where the physician desires to make the urine de- 
cidedly acid ; as, for example, in patients suffering from catarrh of the 
bladder, when the urine is loaded with phosphates, which may be 
dissolved by this acidulation. The dose is 10 to 30 grains, which 
should be dissolved in water. 



Bromide of Ammonium. 

Bromide of Ammonium (Ammonii Bromidum, U. S. and B. P.) is 
really a crystalline salt, but is generally found in commerce as a white, 
granular powder which, when exposed to the atmosphere, becomes 
slightly yellowish. It is readily dissolved in water. 

Physiological Action. — Applied to the mucous membrane of the 
mouth the bromide of ammonium produces a salty taste, is markedly 
pungent, and dissolves readily in the oral secretions. If large amounts 
are swallowed it causes burning pain in the belly and evidences of 
gastro-enteritis. 

Nervous System. — The action of this drug upon this part of the 
body is its most important effect. Given to the lower animals it pro- 
duces in frogs total loss of reflex activity, preceded, it is said, in some 
cases by tetanic convulsions, although no such motor disturbances may 



62 DRUGS. 

take place. In a series of studies undertaken by the writer to deter- 
mine the exact effect of the drug, it was found that the spinal cord was 
depressed, both on its motor and sensory sides, while the nerves and 
muscles escaped. These results are in accord with those of other in- 
vestigators who also found that the nerves are unaffected. On the 
cerebral cortex it acts as a very distinct sedative. 

Circulation. — Upon the circulation bromide of ammonium acts 
as a stimulant in small doses, but as a cardiac paralyzant if a large 
amouut comes in contact with the heart. In medicinal dose it is 
distinctly stimulant to the circulation, but not sufficiently so to render 
it valuable as a circulatory stimulaut. 

Therapeutics. — The bromide of ammonium may be used in nearly 
every iustance where bromide of potassium may be employed, and 
possesses the distinct advantage of being less depressant to the general 
system than the latter drug. It is, however, no less apt to disorder 
the stomach even if given in moderate doses. In epilepsy it would 
seem to be of as much value as the potassium salt, and may be com- 
bined with it in some cases with success. (See article on Epilepsy, 
Part IV.) According to Da Costa, the drug is of very distinct value 
in rheumatism in the dose of 60 to 80 grains a day, well diluted, al- 
though its manner of action in this disease is not known. The usual 
dose is 10 to 30 grains. It is incompatible with spirit of nitrous ether. 



Carbonate of Ammonium. 

Carbonate of Ammonium (Ammonii Carbonas, U. 8. and B. P.) un- 
doubtedly has an action exactly like that of the liquid preparations of 
ammonia, and is used either alone or with the chloride in the treat- 
ment of bronchitis, particularly when this disease occurs in babies and 
young children. It is also largely employed by surgeons in the treat- 
ment of children after surgical operations. The dose is 2 to 10 grains 
in syrup of acacia. It is a rapidly-acting cardiac and respiratory 
stimulant. 

Chloride of Ammonium. 

The Chloride or Muriate of Ammonium (Ammonii Chloridum, U. 8. 
and B. P.) has an entirely different action and therapeutic use from 
the rest of this group. It possesses almost no influence over the heart 
and respiration, but does exercise a very stimulant effect on mucous 
membranes, increasing the secretion of mucus. The consideration of 
its use in diseases of the lungs can be found in the articles on Pneu- 
monia and Bronchitis. Chloride of ammonium fumes can be obtained 
from a few grains of the drug heated in an iron spoon over a gas jet, 
or by means of a set of three wash bottles. In one of these is placed 
stronger water of ammonia, in the other muriatic acid. Each of these 
is connected with a third bottle by means of glass tubing, this bottle being 
partly filled with water, through which the fumes in passing become 



VALERIANATE OF AMMONIUM. 63 

purified, and form the fumes of chloride of ammonium. The drug may 
also be used in a spray from an atomizer. It has been employed 
in intermittent fever, but has gone out of use, and has also been used 
in neuralgias of the ovarian type, by Goodell and others. In the treat- 
ment of chronic torpor of the liver and subacute hepatitis, and even in 
cirrhosis and hepatic abscess, it has been thought of value. Many 
clinicians have found it useful in the treatment of the gastric and in- 
testinal catarrhs of children of a very subacute type, and it is the rou- 
tine treatment for all such cases which come under observation at the 
hospitals and elsewhere where the author has charge. The dose is 2 
to 15 grains, preferably given with liquorice and water to mask the 
taste. The chloride of ammonium may, however, be given in com- 
pressed pills provided a large draught of water or milk is taken 
simultaneously to protect the stomach. (See article on Bronchitis for 
prescriptions.) 

Iodide of Ammonium. 

Iodide of Ammonium (Ammonii Iodidum,U. S.) may be employed 
in the dose of 2 to 3 grains in all cases where the iodide of potassium 
in indicated, and seems to possess alterative influences equal to those 
of that salt. It has been recommended as a local application in cases 
of enlarged tonsils in the form of a solution of 30 grains of the salt 
to the ounce of glycerin, particularly if struma is the cause of the 
enlargement. The application is to be made once a day with a swab 
or cameFs-hair brush. It is necessary that this solution be not exposed 
to the air or it will undergo decomposition. 

Valerianate of Ammonium. 

Valerianate of Ammonium (Ammonii Valerianas, U. S.) is the salt 
of ammonium commonly used in the nervous unrest of pregnant or 
hysterical women, or at the menopause in the peculiar nervous dis- 
orders apt to occur at that period. In poisonous doses it paralyzes the 
spinal cord in the lower animals. It is usually given in the form of 
the elixir of valerianate of ammonium, the dose of which is a tea- 
spoonful to a dessertpoonful, or it is combined with the bromides, un- 
der which circumstances it is much more efficacious. The dose of the 
salt itself is 10 to 15 grains. 

The sulphate of ammonium (Ammonii Sulphas, U. S.) is never 
used in medicine. The phosphate of ammonium (Ammonii Phosphas, 
U. S. and B. P.) is employed in rheumatism in the dose of 10 to 20 
grains. 

The B. P. preparations besides those already given are : Sulphide of 
Ammonium, Oxalate of Ammonium, Liquor Ammonii Oitratis, dose 2 to 6 
fluidrachms, Liquor Ammonii Citratis Fortior, dose 30 minims to 2 
fluidrachms, Liquor Ammonii Acetatis Fortior, dose 25 to 75 minims. 



64 DRUGS. 



AMMONIAC. 

Ammoniac [Ammoniacum, U. S. and B. P.) is a resinous gum 
obtained from Dorema Ammoniaeum and is used very little in medi- 
cine at the present time. Internally and externally it produces some 
irritation when brought in contact with the tissues, and may be used 
internally in the dose of 10 to 30 grains in pills in cases of chronic 
bronchitis devoid of any active inflammatory process. It is official 
in the form of the plaster of ammoniac {Emplastrum Ammoniaci, 
U. S. and B. P.), which is used as a stimulant over enlarged glands 
and joints, and as the plaster of ammoniac and mercury (Ernplastrum 
Ammoniaci cum Hydrargyro, U. S. and B. P.) which is used for the 
same purpose. Finally there is the mixture of ammoniac (Mistura 
Ammoniaci, U. S. and B. P.) used in chronic bronchitis, in the dose 
of a tablespoonful. 

AMYL NITRITE. 

Amyl Nitrite (Amyl Nitris, U. S. and B. P.) is a very volatile, 
somewhat oily, liquid possessing a peculiar penetrating pear-like odor. 
It is made by the action of nitric and nitrous acids upon amylic alco- 
hol, and is not to be confounded with nitrate of amyl, which has a 
different physiological action and is never used medicinally. 

Physiological Action. — When swallowed or inhaled the drug pro- 
duces staggering, fulness in the head, roaring in the ears, duskiness 
of the face, and finally utter muscular relaxation, so that the animal 
or man falls to the ground. The heart beats very rapidly and forcibly, 
and the respiration becomes gasping. 

Nervous System. — Nitrite of amyl acts as the most rapid of all 
the nervous depressants and sedatives known except prussic acid. 
Experiments show that its dominant action is on the motor side of 
the spinal cord. The motor cortex of the brain and the motor nerves 
are only affected by large amounts. Upon the nervous apparatus of 
sensation nitrite of amyl has no effect in medicinal amounts and can 
never be used to relieve pain unless it be due to spasm or to angina 
pectoris. The muscles are depressed by toxic amounts. 

Circulation. — When nitrite of amyl is used the pulse becomes 
exceedingly rapid, while the arterial tension progressively falls. The 
increase in pulse-rate is due to depression of the centric inhibitory 
apparatus of the heart and to the sudden relaxation of the blood- 
vessels, by reason of which, the resistance being taken away, the heart 
beats faster. The fall of arterial pressure is due to a depression of 
the vasomotor centres and the muscular coats of the bloodvessels. In 
very small amounts the drug stimulates the heart muscle (Reichert), 
but its dominant action is that of a depressant. 

The Blood. — In medicinal dose this drug produces a chocolate 
color of the arterial blood, due to the change of oxyhemoglobin into 
meth gemoglobin . 



ANTHRAROBIN. 65 

Urine and Elimination. — The urine sometimes contains sugar 
after the use of the nitrite of arayl, and there is increased diuresis. 
The drug is eliminated very rapidly from the body by the lungs and 
kidneys. 

Temperature. — If the nitrite of amyl be employed for any length 
of time a most remarkable fall in bodily temperature ensues, which is 
probably due to diminished oxidation, but possibly to some effect on 
the heat centres governing heat production and dissipation. The vas- 
cular dilatation also greatly tends to aid in the fall of bodily heat 
produced by the drug. 

Therapeutics. — Mtrite of amyl is used to relax general or local 
muscular spasms, for the relaxation of the spasm of epilepsy and for 
aborting an on-coming fit, for the prevention and subjugation of strych- 
nine convulsions and tetanus, and for the relief of angina pectoris, 
provided the attack is accompanied by high arterial tension. It 
may be used in 'puerperal eclampsia, but it is a dangerous remedy 
because of its relaxation of the uterus and the consequent danger of 
post-partum hemorrhage. In dysmenorrhea with uterine spasm it 
often gives great relief. Nitrite of amyl has been used in cases of sea- 
sickness as a prophylactic and cure with considerable success. In 
cardiac failure from fright or anesthetics amyl nitrite is often of great 
value in single whiffs. If it does not act at once under these circum- 
stances it is worse than useless to push it. It has also been found of 
value in whooping-cough, laryngismus stridulus, asthma, spasmodic 
croup and infantile convulsions. In migraine with local vasomotor 
spasm and true hemianopsia it is very useful. In strychnine poisoning 
and tetanus it must be used between the spasms or else given hypo- 
dermically, as the respiratory cramp prevents its inhalation. 

Administration. — The drug may be given by placing three to five 
drops on a handkerchief and inhaling the fumes, or it may be dropped 
on sugar and taken by the mouth in the same quantity. 

It is important to remember the fact that the effects of the drug are 
more severe for a moment after its use than during its inhalation. 

The physician should warn the patient that the effect of the drug is 
sudden and alarming, and in nervous cases should direct that the in- 
halations be made gently, as a very full inhalation may produce un- 
pleasant sensations of cardiac failure. 

The best way for patients to use the drug is to have it in pearls of 
glass, each holding 3 minims. One or more of these may be crushed 
in the handkerchief and the fumes inhaled. Some of the pearls 
made by careless manufacturers are of such thick, strong glass that 
they are difficult to break, and if broken are apt to cut the fingers. 
These are, of course, to be avoided. 



ANTHRAROBIN. 



Anthrarobin, which was originally discovered by Liebermann, 
seems to possess equal value with its relative chrysarobin, and to be 

5 



66 DRUGS. 

capable of acting as efficaciously as this substance in the treatment of 
skin diseases. It is a yellowish powder, tolerably stable in a dry 
atmosphere, not soluble in acids or water, but readily soluble in 
dilute alkaline solution or alcohol, at first making a solution of a 
brown color, which, as oxygen is taken up, passes to a green and 
finally to a violet. 

Therapeutically, anthrarobin has been employed by Rosenthal and 
by Behrend, and more recently Kobner has recorded his experience 
with it, employing it with good results in a 10 to 20 per cent, solu- 
tion in the various forms of tonsurans as a wash. Rosenthal has 
used it in psoriasis and pityriasis versicolor and herpes, and Behrend 
asserts that it is often better in its effects upon the skin than chrys- 
arobin, as it produces less inflammation and only discolors the skin 
slightly. It also possesses the additional value of making so slight 
a stain on the linen that it can be removed by washing. 

According to most authorities, it is best to keep the drug in alco- 
holic solution, and, if the bottle is well corked, such a mixture 
remains good for a week. 

ANTIMONY. 

Antimony itself, or its oxide, is rarely used in medicine, owing to 
its insolubility, but is generally employed as the tartrate of antimony 
and potassium, or Tartar Emetic (Antimonii et Potassii Tartras, U. 8. ; 
Antimonium Tartaratum, B. P.), or in the form of the sulphide (Anti- 
monii Sulphidum, U. 8.) ; purified sulphide (Antimonii Sulphidum 
Purijicatum, U. S. ; Antimonium Nigrum Purijicatum, B. P.) ; and 
sulphurated antimony [Antimonium Sulphuratum, U. 8. and B. P.). 
The last three drugs are so rarely employed and are such unreliable 
and useless preparations that they will probably be dropped in the 
present revision of the Pharmacopoeia. 

Tartar Emetic. 

Tartar Emetic {Antimonii et Potassii Tartras, U. 8. ; Antimonium 
Tartar atum, B. P.) is made by boiling the oxide of antimony with 
bitartrate of potassium and water. Although it is really crystalline 
it is generally sold as a fine powder, owing to these crystals being 
easily pulverized. It is insoluble in absolute alcohol, but is soluble 
in ordinary water, and still more so in boiling water. In dilute 
alcohol it is partly soluble. 

Owing to its chemical constitution tartar emetic should never be 
given with either acids or alkalies, and all drugs containing tannic 
acid are also incompatible with it, owing to the fact that an insoluble 
tannate is rapidly formed which is absorbed very slowly if at all. 
So complete is the insolubility of the compound so formed that tannic 
acid is the best antidote to the drug that we possess. 

Physiological Action. — Tartar emetic, when applied to mucous 
membranes, produces a burning sensation, and upon the skin it may 



ANTIMONY. 67 

readily cause a large amount of irritation if the part be delicate. If 
kept in contact with a mucous membrane very distinct inflammatory 
changes occur, and if it be applied to the skin for any length of time, 
redness, followed by acne of a pustular character, appears, which 
finally ends in ulceration and sloughing if the use of the drug is 
persisted in. Under these circumstances the vitality of the parts 
seems interfered with, and, as a result, healing takes place very slowly 
indeed. 

Xervous System. — Antimony is a depressaut to the sensory side 
of the spiual cord and a paralyzant to all the spinal centres, motor 
and sensory, in poisonous dose. 

It is stated that sensation to heat and acids is lost before the 
ordinary sense of touch is destroyed. The convulsions which some- 
times ensue after poisonous doses in the lower animals are due to 
anaemia of the brain brought ou by the circulatory depression. Ringer 
and Murrell have proved antimony to be a motor-nerve and muscle 
poison. 

Circulation. — The chief influence of antimony is exerted upon 
the circulation. In small doses it lowers the pulse-rate by a direct 
depression of the heart-muscle, and simultaneously decreases arterial 
tension by an action upon the peripheral portions of the vasomotor 
system in the walls of the bloodvessels, but the vasomotor influences 
may be in part centric, and this question must be considered as sub 
judice. The fall of arterial pressure is also due to failure of heart 
force. With the lowering of the pulse-rate there is nearly always a 
corresponding decrease in cardiac power. 

AVhen poisonous doses are employed death ensues after great circu- 
latory and respiratory depression, as will be seen below. The heart 
is found relaxed and flabby and utterly dead to all stimuli, although 
if the dose has not been very excessive and digitalis is freely employed 
the heart may be made to beat again ; this is at least true in the frog. 
The drug in poisonous doses is thought to depress the peripheral ends 
of the vagus nerves. 

Respiration — The drug has little or no effect upon respiration 
except when given in lethal doses. Under these circumstances death 
is produced in three ways, all of them acting together. Primarily, 
the respiratory centre in the medulla is depressed, and the governing 
nerves of breathing, the pneumogastrics, are also rendered inactive ; 
secondarily, the cardiac failure readily causes pulmonary congestion ; 
and, thirdly, the drug causes such an outpouring of liquid and mucus 
into the bronchial tubes that the patient is drowned in his own 
secretion, which he is too weak to expel. 

Stomach and Intestines. — Antimony in toxic doses is a powerful 
irritant to these portions of the body. In full medicinal amounts it 
acts as a slow but powerful emetic, producing much nausea. The 
vomiting is due to an action on the vomiting-centre in the medulla and 
to a direct action on the stomach itself. The drug is, therefore, a 
centric and peripheral emetic. 



68 DRUGS. 

Very full doses produce watery purging attended with, some griping 
and tenesmus. 

Elimination. — Antimony escapes from the body in all the secre- 
tions, but largely by the bowels. The latter method of elimination 
seems chiefly to follow poisonous doses, and Wood believes with others 
that purging is an effort at elimination. 

Poisoning. — When toxic doses of tartar emetic are taken the pulse 
at first becomes slightly weaker and slower, the skin becomes moist and 
relaxed, a general sense of relaxation comes on, and simultaneously a 
sensation of severe nausea and gastric distress appears. 

Following this condition violent vomiting asserts itself. The ejected 
mass consists of the contents of the stomach, mucus, bile, and watery 
fluids, and perhaps blood. Purging appears almost as early as the 
vomiting, and consists first of the normal contents of the intestines, then 
mucus, then bile, and, very rarely, blood. These signs may rapidly pass 
away and the characteristic peculiar " rice-water " stools 1 appear. 
The general condition of the patient is now most serious. The face is 
pinched, livid, and covered with a cold sweat. The pulse is rapid and 
shuttle-like — to and fro — or lost at the wrist ; the arterial tension is 
almost nil. The respirations are faint and fluttering, and so shallow 
as hardly to be seen or heard. Cramps in the calves of the legs attack 
the patient, due to the abstraction of water from the tissues by the 
violent purging, and the temperature falls lower and lower as death 
approaches. The general condition is such that all the signs point to 
Asiatic cholera, and antimonial poisoning cannot be separated from 
this disease without a history of the case or a chemical analysis of the 
secretions, which ought always to be preserved. 2 

The treatment of antimonial poisoning consists in the internal ad- 
ministration of large amounts of tannic acid, in the use of the stomach- 
pump, and in the maintenance of an absolutely prone position. The 
patient should vomit into towels and not raise the head from the ground ; 
the head, indeed, should generally be placed lower than the heels. 
External heat, alcohol, and digitalis should be thoroughly used, and 
opium should be employed hypodermically to allay pain and irritation, 
unless the respirations are too feeble. 

Fatty degeneration of the tissues may occur after acute antimonial 
poisoning. 

Therapeutics. — Tartar emetic is employed for at least five separate 
purposes, the most usual of which is as a circulatory quieter and seda- 
tive. The indications for antimony as a circulatory depressant are not 
so generally recognized at present as they were at one time, on account 
of the introduction of other drugs. Suffice it to state that all states of 

1 A " rice-water " stool is one which, on standing in a glass, separates into two lay- 
ers, the lower white and flocculent, the upper watery and almost clear. 

2 This is probably as good a place as will occur to state that the secretions and ex- 
cretions of a person dying of any poison should be placed in a chemically-clean jar 
capable of being sealed tight. The same rule of cleanliness applies to the jars hold- 
ing organs at the post-mortem. The jars should be ready, and no intermediate vessel 
used. They should be sealed at once, and kept so until claimed by the authorities. 



ANTIMONY. (jy 

sthenic inflammation with a bounding pulse, high fever, and symptoms 
showing the patient to be possessed of robust constitution, permit of its 
use, while all asthenic conditions most emphatically contra-indicate 
its employment. In the treatment of colds, to break forming diseases, 
and to allay inflammation, it is given in moderate dose. It is useful 
in sthenic bronchitis as an expectorant. Under these circumstances 
it may be given in emetic dose ; or, if emesis is not desirable, minute 
amounts given hourly are of value, such as -fa of a grain every hour, 
or a teaspoonful of a solution of 1 grain to a half-pint every hour may 
be used. This is a particularly useful method in children, as the solu- 
tion is tasteless, and it does not produce nausea and vomiting. 

In the acute catarrh of children, which affects the stomach and entire 
alimentary canal and is associated with little fever, the use of the drug 
is extremely valuable, and often aborts an attack in the same dose as 
just described. 

As as emetic antimony is slow but forcible, and it ought not to be 
used in poisoning owing to its slowness. 

Before the introduction of anaesthetics, emetic doses were employed 
to relax the muscles in reducing dislocations and fractures. 

Tartar emetic is harmful if irritation of the stomach is present or if 
kidney lesions are active, and if one good-sized emetic dose is not suffi- 
cient to produce vomiting, it should not be repeated, but some other 
emetic or the stomach-pump be used, lest antimonial poisoning com- 
plicate the case. This dose must be large enough to be effective, or 
none at all should be given. If this rule is disobeyed systemic changes 
come on with undesirable severity in those cases where emesis fails to 
occur. 

As a counter-irritant antimony is employed in the form of an oint- 
ment whenever a very slowly acting and prolonged counter-irritation 
is to be maintained, as on the back of the neck in epilepsy or similar 
chronic states, and in old enlargements of the joints. 

Antimony acts w T ell as a diaphoretic, but its use is unnecessary ow T ing 
to its disagreeable effects, such as nausea and intestinal disturbance, 
and because other, more pleasant, drugs act equally well. 

Administration. — The dose of tartar emetic, when there is an excited 
circulation, is -fa to -fa of a grain every three hours until an effect is 
obtained. As an emetic the dose is J to 1 grain. The wine of antimony 
( Vinum Antimonii, U. S. ; Vinum Antimoniale, B. P.) contains only 
two grains of tartar emetic to each ounce, and may be used in the dose 
of j- to 1 teaspoonful, or, as an emetic, in the dose of 1 to 2 tablespoon- 
fuls. The compound pill of antimony (Pihdce Antimonii Compositor, 
TJ. S.) is used as an alterative, and contains sulphurated antimony j- 
a grain, calomel \ a grain, guaiac 1 grain, and tragacanth ;. the close 
is 1 to 3 pills. 

The ointment of antimony ( Unguentum Antimonii Tartarati, B. P.) 
is used externally as a counter-irritant spread on a rag or piece of lint. 
Antimonial pow T der (Pidvis Antimonialis, U. 8. and B. P.) or James's 
powder, contains oxide of antimony and phosphate of calcium, and is 



70 DRUGS. 

given occasionally as an antipyretic in the treatment of rheumatism 
and fever in the dose of 3 to 10 grains ; it is best given in a pill. 

The compound syrup of squill (Syrwpus Scillce Compositus, JJ. S.), 
otherwise known as " Coxe's Hive Syrup/' contains three-fourths of 
a grain of tartar emetic to the ounce. The dose is 20 to 30 drops for 
an adult as a sedative, or from this amount to 1 drachm to a child as 
an emetic. Liquor Antimonii Chloridi, B. P., is not official in this 
country, and in England is rarely used, as an escharotic. 



ANTIPYRINE. 

Antipyrine is a derivative of coal tar, its chemical name being 
dimethyloxyquinizine. In appearance it is a white powder of a some- 
what bitter taste and is very soluble in water, less so in ether, alcohol, 
and chloroform. 

When antipyrine is given to a man in full medicinal amount it 
causes a buzzing and tightness of the head not unlike that produced 
by quinine. The bodily temperature, if normal, is depressed a frac- 
tion of a degree, but no other symptoms are manifested. If the dose 
be quite large some blueness of the lips and finger-nails appears, 
chilly sensations are experienced, and finally a profuse sweat breaks 
out over the entire body, which is more severe if fever has previously 
existed. Large doses sometimes cause nausea and vomiting. 

Physiological Action. Nervous System. — When a poisonous 
dose of antipyrine is given to one of the lower animals, relaxation, 
utter loss of reflex action, and total inability to move come on at once 
and death ensues. Somewhat smaller doses produce exceedingly 
severe tetanic and epileptiform convulsions, but consciousness seems 
to be preserved. It has been proved that the chief cause of the 
convulsion is an action of the drug on the brain. 1 Very large toxic 
doses, therefore, decrease reflex action and smaller ones increase it, 
though medicinal amounts certainly lessen reflex activity to a notable 
degree. The cause of this failure of reflexes is depression of the 
sensory nerves and the receptive centres of the spinal cord. Medici- 
nal amounts must, therefore, be regarded as very distinct nervous 
sedatives, acting much more actively on the nerves of sensation than 
on those of motion. 

Circulation. — The studies of a very large number of pharma- 
cologists prove most conclusively that antipyrine has no effect on the 
circulation of the lower animals in moderate doses, unless these be so 
frequently repeated that cumulative effects ensue. Many reliable 
clinical observers have asserted that the drug depresses the circula- 
tion in man in some cases, and antipyrine is certainly not a cardiac 
stimulant. The writer is confident, however, that antipyrine is not so 
distinctly a cardiac depressant as some think. Large, poisonous doses 
lower blood-pressure, unless convulsions are present, when the pressure 

1 See author's Boylston Prize Essay on Antipyretics. Philadelphia, 1891. 



ANTIPYRINE. 71 

is raised. The action of the drug on the circulation is nevertheless a 
very unimportant part of its power, and in most cases is not to be 
considered in the treatment of disease. In many of the cases where 
vascular depression and collapse have followed its use it has been 
employed in excessive amounts, or the fall in bodily temperature has 
caused the untoward symptoms. (See Fever and its Treatment.) 

Blood. — No spectroscopic changes in the blood follow the use of 
medicinal doses of antipyrine in the ordinary individual, but in 
poisonous amounts it produces methsemoglobin. If the doses be toxic, 
or idiosyncrasy exists, cyanosis may come on. That the blood is not 
destroyed by small amounts is proved by the absence of hsematin in 
the urine of persons taking the drug. The corpuscles suffer no 
changes except in very pronounced poisoning, when they are said to 
become crenated and shrivelled. 

Respiration. — When antipyrine is given in lethal doses death 
results from failure of the respiratory centre. Ordinary doses have 
no effect on this function, but large ones make the breathing more 
rapid. 

Temperature. — In normal men and animals antipyrine in medici- 
nal dose may be considered as without effect so far as bodily tempera- 
ture is concerned. In fevered" animals it has been found to lower 
temperature by decreasing heat production and increasing heat dissi- 
pation. That it does not do this by an action on the blood seems 
proved by the fact that the blood is not affected by medicinal amounts. 
The sweating does not cause the fall, since it takes place when no 
sweating occurs. It may, therefore, be considered that the drug 
directly affects the nervous heat-mechanism of the body. 

Kidneys, Tissue-waste, and Urine. — A large number of 
studies made upon man and the lower animals by competent investi- 
gators have brought about very considerable advances in our knowl- 
edge of the influence of antipyrine upon tissue-waste. It is useless 
to burden this volume with a discussion of their methods and results, 
which may be found in the author's Essay on Antipyretics. Suffice it 
to say that while all observers are not agreed as to the effects produced, 
the deductions apparently to be drawn are that the drug diminishes 
the quantity of the urine excreted, and also decreases the elimination of 
the results of nitrogenous tissue metamorphosis — or, in other words, 
is a conservator of the tissues of the body. 

Elimination. — The elimination of antipyrine goes on very rapidly 
indeed, and begins almost at once after its ingestion. Maragliano 
states that it appears in the urine in three hours after it is taken, 
so that at the fourth hour elimination is at its height, although it 
continues for twenty-four or perhaps thirty-six hours. According to 
Pavlinow, part of the antipyrine ingested is eliminated by the salivary 
glands. 

Toxic Effects from Prolonged Use. — After chronic poisoning by 
antipyrine a post-mortem examination shows intense engorgement of 
the brain and meninges, with a serous exudate into the cerebral 
ventricles. The lungs are highly congested, the spleen is small and 



72 DRUGS. 

shrivelled, and the kidneys are filled with blood and slightly inflamed. 
The liver is not much affected, but the blood-corpuscles are greatly 
decreased in number. 

Poisoning. — The treatment of poisoning by antipyrine consists in 
the administration of stimulants, the maintenance of bodily heat, the 
use of atropine to restore the tone of the vascular system, and if 
cyanosis is alarming the employment of oxygen inhalations. 

Antiseptic Power. — Antipyrine exerts a very distinct antiseptic 
action in small amounts, delays all forms of fermentation, and 
destroys germs when it is present in large quantity. 

Therapeutics. — Antipyrine is employed in medicine for two great 
purposes — namely, for the reduction of fever and the relief of pain, 
but its employment as an antipyretic is now entirely surpassed by its 
use as an analgesic. 

As an antipyretic, antipyrine should be given in a few large doses 
rather than frequent small ones, as a general rule, since if the fever 
is of any severity the latter method of administering it will have 
no effect. On the other hand, too large closes may depress the tem- 
perature to a point below normal, and induce collapse. In the article 
on Fevers the conditions are indicated in which the drug is best em- 
ployed, these being the sthenic fevers, as a rule, or instances where 
excessive outbursts of fever necessitate prompt reduction of tempera- 
ture. Under these conditions, antipyrine is the best adjunct to the 
cold pack. In excessively high temperature in pneumonia it is of 
great value, and in scarlet fever and smallpox antipyrine is of service 
in some instances. In pneumonia, as a rule, the condition of the 
patient indicates at first cardiac depressants rather than antipyretics. 
In phthisis antipyrine generally increases the sweating, produces 
oppression, and either fails to act at all or produces collapse by 
producing too great an effect In sunstroke it frequently fails to 
influence the temperature 

Be the fever what it may, provided it be associated with any dis- 
eased process, antipyrine is absolutely useless so far as any influence 
over the course of the disease itself is concerned. It is a remedy to 
be used in the treatment of symptoms, not in the removal of the 
cause of the fever. 

As an analgesic antipyrine is the peer of opium. Although the 
latter drug will relieve all forms of pain if it be pushed, it possesses 
many disadvantages not found in antipyrine. In deep-seated pains 
due to disease of the organs of the body, in inflammations and similar 
disturbances, antipyrine is useless. In neuralgic affections of all 
kinds it finds its sphere, particularly if the disorder be rheumatic, 
gouty, or due to nervous depression a disease. Under the latter 
circumstances it is best combined with caffeine and a little bromide of 
potassium (see Neuralgia). In rheumatism it will give relief in a fairly 
large number of cases, not only relieving the pain and fever, if they 
be present, but also actually modifying the disease. It seems, however, 
to increase sweating in acute articular rheumatism. In gout it is 
stated to have a specific curative effect upon the disease, over and 



ANTIPYRINE. 73 

above the relief of the pain, but this is doubtful. Its use in dysmenor- 
rhea has been recommended, but its beneficial influence in such cases 
is doubtful. At one time it was thought that its use would relieve 
the pains of labor entirely, but this has, unfortunately, proved untrue. 
It may, however, be tried when the suffering is very severe, in the dose 
of 15 grains. In the severe lancinating or darting paius of locomotor 
ataxia, and in the laryngeal and gastric crises complicating this disease, 
antipyrine is an invaluable and reliable remedy. Curiously enough it 
seems to subdue acute attacks of pain in posterior sclerosis, but fails to 
control the slighter pains and muscular twitchings sometimes seen in 
this disease and in myelitis. 

Some clinicians have used antipyrine with asserted great success in 
diabetes mellitus. Antipyrine may be used hypodermically in the 
case of a hypersensitive nerve as a local anaesthetic. The anaesthesia 
produced by it lasts for several days, but the pain immediately after 
the injection is excruciating. 

Antipyrine is a very useful remedy in epilepsy. 

In whooping-cough antipyrine has given relief more frequently in 
the writer's experience than any other remedy. It should be given 
to a child of five years in the dose of 2 grains every four or five 
hours, the patient being watched for cyanosis and the drug stopped as 
soon as this symptom appears. Antipyrine frequently decreases the 
frequency rather than the force of the attacks of cough. 

In malarial diseases antipyrine certainly exercises no antiperiodic 
influence, although it controls the febrile paroxysms to a great extent. 
Yet, while this is the opinion of the majority of those who have used 
it, it cannot be said that every observer has reached similar conclusions. 
Potter reports cases where the results obtained from its use were most 
satisfactory, particularly in the intermittent form of malarial poison- 
ing. One cannot help thinking that frequently where antipyrine has 
been reported as acting as an antiperiodic, it has simply lowered the 
fever and so seemed to affect the disease. 

Untoward Effects. — Aside from the results of poisonous doses, a 
large number of cases present slight cyanosis or duskiness of the hands 
and of the face about the nose and lips ; the ringers may be cold and 
clammy, and the feet are often very cold ; sweating is a very common 
symptom of the untoward influence of antipyrine, and pricking or 
tingling of the skin is not uncommonly seen. By far the largest 
number of these cases, however, suffer from disorders associated with 
the skin, and erythematous patches may be seen everywhere, more 
particularly on the hands and feet, and about the face, arms, and chest. 
Occasionally pemphigus-like spots appear, and often large bullae have 
been noted as present. Elsewhere are published the statistics, collected 
from medical literature, of 121 cases of untoward effects exercised by 
antipyrine. 1 An analysis of these shows that females were much 
more frequently affected than males, and that the most susceptible age 
was decidedly that of full adult life — namely, from thirty to forty 

1 See author's Essay on Antipyretics. Philadelphia, 1891. 



74 DRUGS. 

years in both sexes. The dose causing these effects was most com- 
monly a moderate one — from 10 to 15 grains, or even from 4 to 10 
grains. This fact holds good with regard to both sexes. The time 
of onset of the symptoms varied somewhat, according to whether 
the drug was given in one excessive dose or in frequently repeated 
medicinal doses. In many instances the appearance of the symptoms 
was sudden rather than gradual. As a rule the duration of the 
symptoms did not exceed one to three hours, three days being the 
longest time mentioned. It is interesting to note, however, that of 
all these cases only six proved fatal, and in these there was ample 
cause for death aside from any effect of the drug. We can rest 
assured, therefore, in ordinary cases of disease, that patients exhibiting 
untoward effects of antipyrine are not in any acute danger, although 
the symptoms may be temporarily most alarming. Typhoid fever 
seems, according to the statistics collected by the writer, to be the 
disease in which this unexpected influence manifests itself most fre- 
quently, but this may be due to the fact that it is so common a 
malady, and is so frequently treated by means of antipyretics. 

Administration. — Owing to the solubility of antipyrine, it is most 
readily given in a little water in a wineglass or spoon. If its slight 
taste is disliked, it may be dissolved in any one of the aromatic waters, 
or in syrup of bitter orange peel, or some similar vehicle. Most per- 
sons prefer to take it with water. The amount which may be given 
at a dose is 5 to 20 grains, 5 grains being perhaps the best dose in 
most cases. 

Incompatibles. — When added to sweet spirit of nitre, antipyrine in 
the course of a few moments produces a blue, changing to a dark- 
green, color, owing to the formation of iso-nitroso-antipyrine, which is 
not poisonous, but when in the form of a dry powder is readily oxi- 
dized on exposure to slight heat. If this color is not formed the 
spirit of nitre lacks its nitrous ether and is worthless, so that we have 
not only another incompatibility to remember, but a new means of 
testing the therapeutic value of all samples of sweet spirit of nitre 
which may be dispensed by druggists. Calomel and antipyrine have 
also been found to be incompatible. 



APIOL. 

Apiol is a yellowish, oily liquid with a specific gravity greater than 
water, an acid taste, and curious odor. It is derived from common 
parsley, or Petroselinum. So far as is known to the author, no careful 
study of its physiological action has ever been made, but two French 
observers, Joret and Homolle, state that in overdose it causes ringing 
in the ears, intoxication, and severe frontal headache. 

Therapeutics. — Originally introduced to combat malarial fevers, 
because of a fancied resemblance in its toxic action to quinine, apiol 
has at last found its true level as a remedy in amenorrhoea, given in 
the dose of 2 to 8 minims three times a day for a week before the 



APOMORPHINE. 75 

proper date for menstruation. It should be given, if possible, in 
capsules owing to its bad taste. It is said not to possess any abortive 
influences, although it is often taken with this object in view. 

Apiol is imported from France in capsules containing a little less 
than 3 minims. 

APOMORPHINE. 

Apomorphine is an artificial alkaloid obtained by the action of 
hydrochloric acid upon morphine in a sealed tube to which is applied 
a high heat. It is a whitish or gray powder, made up of minute crys- 
tals, which rapidly undergo decomposition when exposed to the air. 
The drug should be kept in dark bottles well stoppered. A very 
important point to remember is that old solutions rapidly decompose, 
and, if employed, may produce poisonous symptoms. The drug ought 
to be freshly dissolved each time it is used. 

Physiological Action. — One of the best studies of this drug is that 
of Reichert, who found that in poisonous doses it produces convul- 
sions, and finally paralysis which is chiefly spinal in origin. 

Nervous System. — On the nervous centres in the brain apomor- 
phine acts as a stimulant, but the convulsions produced by poisonous 
doses are probably spinal. The motor and sensory nerves are finally 
paralyzed, and even the muscles become poisoned and incapable of 
contraction. 

Circulation. — Apomorphine increases the rapidity and force of 
the pulse and raises arterial pressure, when given in moderate amounts, 
by stimulation of the accelerator nerves and the vasomotor centre. 
In large doses it acts as a circulatory depressant. 

Respiration. — After ordinary amounts no changes in respiration 
occur, but after poisonous doses the breathing becomes rapid and 
irregular. 

Vomiting. — Vomiting is produced by a direct action of the drug 
upon the vomiting centre in the medulla, and not by an action on the 
stomach. Apomorphine is, therefore, a typical centric emetic. 

Therapeutics. — Apomorphine is useful in nearly all cases where an 
emetic may be employed. In poisoning from other drugs, particu- 
larly depressants and narcotics, we have little knowledge of its safety, 
but, unless the stupor or circulatory change is very profound, the 
drug may be used with care. In subacute and chronic catarrh of the 
stomach and air-passages it may be useful in getting rid of the mucus 
by emesis, and it is a useful remedy in acute bronchitis when it is 
necessary to quiet irritation, or when the secretion which has been 
poured out is very scanty. 

Administration. — The drug when used as an emetic should always 
be given hypodermically and the solution be freshly prepared. The 
emetic dose is about ^ of a grain, but as much as \ may be used in 
strong patients. The expectorant dose is fa to 2V °f a g ram by the 
mouth. No nausea is usually felt. The drug nearly always acts 
badly in children, and it is better not to use it in this class of patients. 



76 DRUGS. 

The salt used is Apomorphine Hydrochloras, U. S. and B. P. An 
injection (Injectio Apomorphine Hyp oder mica — 2 grains dissolved in 
100 minims of camphor- water) is official in the B. P. 



ARISTOL. 

(See Thymol Iodide.) 

ARNICA. 

Arnica is a medicine derived from Arnica montana, a native plant 
of the Western United States and Europe. It holds a very high posi- 
tion in domestic medicine as a local and internal remedy in sprains 
and bruises, and in the treatment of passive hemorrhages, amenor- 
rhea, and similar states. Two parts of the plant are official, the 
arnica flowers (Amice Flores, U. S.) and the root {Amice Radix, 
U. 8. 9 Amice Rhizoma, B. P.) 

Physiological Action. — When arnica is applied to a delicate skin it 
produces burning and irritation, and even extensive skin lesions. Ac- 
cording to the studies of the author it slows the pulse, raises the 
blood-pressure slightly, and stimulates the vagus nerves. Toxic doses 
produce a rapid pulse from paralysis of these nerves. 

Administration. — Arnica is rarely given internally. If it is so used 
the dose of the tincture (Tlnctura Amice Radicis, U. S.) is 15 to 30 
drops, and the same amount of the tincture of the flowers {Tlnctura 
Amice Florum, U. S.) may be employed. The solid {Extraction 
Amice Radicis, U. S.) and the fluid extract of the root (Extr actum 
Amice Radicis Fluidum) are also official. The dose of these prepara- 
tions is 3 to 5 grains and 5 to 10 minims respectively. The plaster 
(Emplastrum Amice, U. S.) is very useful for external applications. 

The tincture is the preparation usually applied to sprains and 
bruises, and the alcohol contained therein accomplishes a large part 
of the good achieved. 

The only British preparation is the tincture {Tlnctura Amice), 
which is given in the dose of 30 minims to 1 drachm. 



ARSENIC. 

Arsenic (Arsenicum) itself is never employed in medicine, but it is 
used in the form of arsenious acid or the arseniates of sodium, potas- 
sium, or copper. 

Arsenious acid is derived from arsenic-bearing ores by roasting them 
in a reverberatory furnace, when it rises in the form of a vapor which 
adheres to the walls of the furnace, requiring a second sublimation 
owing to the first deposit being quite impure. It is soluble in water, 
is without odor, and when heated gives off the smell of garlic. 



ARSENIC. 77 

Physiological Action. — The changes produced in man by poisonous 
doses will be found considered under the heading of Poisoning, and 
the writer will now confine himself to a study of the effects of medi- 
cinal amounts. 

Applied to the normal skin arsenious acid produces no change of 
any moment whatever, but if the surface be broken or a wound or 
sore exist its action is very powerful, and it destroys the tissues to a 
considerable extent. For this reason it has been employed as a caustic 
by "quacks" and to some extent by regular physicians, the latter 
using it to remove warts, condylomata, and similar growths, while the 
former have employed it chiefly as a " cancer cure," asserting that it 
would take the disease " out by the roots." 

Nervous System. — When small amounts of arsenic are given to 
animals, particularly those of the lower types, as represented by the 
frog, reflex action is lost long before, or more rarely at the same time 
that voluntary movement is put aside, and, finally, all sensation to 
pain produced by heat and pinching totally ceases. It is, therefore, 
quite evident that the sensory nervous apparatus is affected, and ex- 
periments have proved that the sensory tract of the spinal cord is at 
fault. Ultimately, however, the motor system also fails and complete 
motor palsy ensues. Arsenic in poisonous amount acts as a depressant 
poison to all protoplasm with which it may come in contact. (Ringer 
and Murrell.) In medicinal amounts the drug acts as a nervous ex- 
citant and as a stimulant to the trophic nervous apparatus. 

Circulation. — In moderate amounts arsenic has little or no in- 
fluence upon the circulation. Large doses cause marked decrease in 
the force and frequency of the pulse, accompanied by a decided fall in 
arterial pressure, and in these amounts it is to be regarded as a distinct 
cardiac depressant which depresses all the heart's component parts, such 
as the ganglia, muscle, and nerves. The fall of the arterial pressure is 
due to vasomotor depression with relaxation of the general bloodves- 
sels, more especially those of the abdominal cavity. According to 
Lesser, small doses cause it to act as a cardiac stimulant, increasing 
the pulse-rate. Arsenic is absorbed by the bloodvessels. 

Respiration. — In small amounts arsenic very distinctly stimulates 
the respiratory centre, and Lesser asserts that small doses stimulate the 
peripheral ends of the vagi in the lungs, but that in toxic quantities 
arsenic acts as a powerful respiratory depressant. 

Elimination. — Arsenic escapes from the body chiefly by the kid- 
neys and bowels. In poisoning, the purging which is produced carries 
off much of the drug, but after medicinal amounts some traces of it 
may be found in the saliva and in the milk of nursing women. The 
writer has seen colic produced in infants taking milk at the breasts of 
women who were receiving large doses of Fowler's solution. 

Tissue-waste. — According to Chittenden 'and Cummins, arsenic in 
medicinal amount distinctly decreases tissue-changes. Large doses, 
however, greatly increase nitrogenous metamorphosis. 

Therapeutics. — Arsenic is used in chorea, in which it is almost a 
specific, acting in an unknown manner. Small doses should be given 



78 DRUGS. 

at first, and later on the dose should be rapidly increased, as patients 
soon get accustomed to the drug. As a tonic combined with iron it is 
invaluable in malarial ancemia and cachexia. In atony of the mucous 
membrane of the stomach and intestines it is exceedingly useful, and 
in ordinary anoemia and debility, combined with a simple bitter tonic, 
it is invaluable. In malaria it acts as a prophylactic, as a cure, and 
as an aid to convalescence. Next to quinine it is the best antiperiodic 
that we have. When the attacks of intermittent fever are far apart, 
arsenic is useful between the paroxysms as an antiperiodic, quinine 
being withheld for use during the attack itself. In ordinary neuralgia, 
due to eye-strain or debility, it is very useful, and in gastralgia it is of 
great service. The author desires to speak particularly of the employ- 
ment of arsenic for the improvement of depraved mucous membranes 
of the respiratory tract, particularly in those persons who have not 
true tuberculosis but phthisical tendencies — that is, individuals who 
continually have colds in the head, chest, or elsewhere. The prolonged 
use of arsenic for months at a time will often cure these cases. 

No drug is so universally abused as is arsenic in the treatment of 
skin disease ; it should never be employed in " wet " skin diseases — 
that is, those associated with much proliferation of new cells and the 
exudation of serum and other liquids. Its field of usefulness is in 
the dry, scaly skin affections. 

Where the skin is affected in its lower layers arsenic is useless and 
should be used only where the epiderm is diseased (Duhring). 

In psoriasis arsenic at first makes the skin more red and seemingly 
worse, but this passes oifand the disease gets well. This is important 
to remember, as otherwise the drug may be stopped just at the wrong 
time. Pemphigus, lichen, and lepra all yield to its influence in most 
instances. 

In the treatment of diabetes and pruritus vulvce the drug is said to 
be of value when given internally. In gouty diabetes the use of the 
carbonate of lithium and the arseniate of sodium is often of great 
service. 

In asthma, particularly where the mucous membranes are at fault, 
arsenic is one of the best remedies that we have, either given internally 
or smoked in arsenic cigarettes, which are to be made as follows i 1 

K . — Belladonna? foliorum gr. xcyj. 

Hyoscyani. foliorum . . . . . gr. xlv. 

Stramonii foliorum . . . . . gr. xlv. 

Extract, opii ...... gr. iv. 

Tabaci ....... gr. lxxx. 

Aquae Oj. M. 

Ft. sol. et adde 

Potassii nitratis ...... gr. clx. 

Potassii arsenitis ...... gr. cccxx. M. 

Bibulous paper is to be wetted with this compound, and after drying is to be rolled 
up and smoked in a cigarette. 

A more simple procedure is to wet bibulous paper in a solution of 
arsenite of potassium of the strength of fifteen grains to the ounce. 

1 See Philadelphia Hospital Pharmacopoeia. 



ARSENIC. 79 

In chronic rheumatism arsenic is very valuable in certain cases, but 
often fails to be of service. In coryza, in cancrum oris, severe sore- 
throat, and chronic nasal catarrh it is to be employed internally, and 
in some cases of hay-fever undoubtedly affords relief. The use of 
arsenic in all stages of phthisis often gives the most surprising results. 
In gastric cancer and ulcer, given in small amounts frequently repeated, 
arsenic will often do good by relieving the pain and checking the 
vomiting. It may be tried in the vomiting of pregnancy with some 
chance of success. In atonic dyspepsia associated with chronic diarrhoea, 
and with evidences of dysentery, arsenic is of service, and in small 
amounts it is very valuable in frequently repeated doses (-j-j-g- of a grain 
every hour), in all forms of serous diarrhoea. 

For gastric atony or torpidity the following prescription is useful ; 
but if irritation of the stomach is present it should not be employed : 

R — Liq. potas. arsenit. f^ss. 

Tr. nucis vomicae f ^j. 

Aquae q. s. ad f^iij. M. 

S. — Teaspoonful t. d. in water after meals. 

In old persons whose feet become swollen and hot after prolonged 
standing and who have shortness of breath on exertion, arsenic does 
good. 

Locally applied to warts and other growths of the skin for several 
days in the form of Liquor Arsenicalis (P. P.), or Liquor Acidi Ar- 
seniosi, or of Fowler's solution, it causes the growth to drop off or 
to become very much loosened. Where the growth is very hard and 
horny its surface should be softened by the application of liquor 
potassa before the arsenical liquor is applied. The same plan may be 
used for corns, and salicylic acid is employed in a similar manner, but 
is not so efficient. Where large growths with wide surfaces are to be 
attacked the physician must use arsenic most boldly or not at all. 
The danger of absorption is only escaped when the drug is used so 
generously as to destroy the tissues before they can carry on any 
absorption of the poison. Marsden recommended the use of one ounce 
each of arsenious acid and powdered gum acacia to five drachms of 
water as an application to epitheliomatous growths. 

Administration. — Children generally bear more arsenic than adults, 
proportionately, and Einger states that boys bear less than girls. The 
drug should generally be administered after meals, as it is apt to irritate 
the stomach if given when this viscus is empty. Whenever a patient 
is given arsenic he should be cautioned to. watch for any puffiness 
about the eyes, particularly in the morning on arising, and for slight 
laxity of the bowels and griping. These are signs that the drug 
should be stopped for a day or more. The swelling under the eyes 
may spread if the use of the drug is persisted in, and finally amount 
to general anasarca. This is due at first to a cellulitis, and afterward 
to a true effusion. 

The official preparations are : arsenious acid (Acidum Arseniosum, 
U. S. and B. P.), the dose of which is -^ to -^V of a grain, the solution 
of the arsenite of potassium [Liquor Potassii Arsenitis, U. S. ; Liquor 



80 DRUGS. 

Arsenicalis, B. P.), or Fowler's solution, the dose of which at first is 
from 1 to 5 drops in water; the solution of arseniate of sodium 
{Liquor Sodii Arseniatis, U. 8. and B. P.), or Pearson's solution, the 
dose of which is 1 to 5 drops, and the solution of arsenious acid 
{Liquor Acidi Arseniosi, U. 8. ; Liquor Arsenici Hydrochloricus, B. 
P.), the dose of which is 1 to 5 drops. This is more irritating to the 
stomach than the other preparations. The iodide of arsenic enters 
into Donovan's solution (Liquor Arsenii et Hydrargyri Iodidi, U. 8. 
and B. P.), the dose of which is 1 to 3 drops well diluted. Iodide of 
arsenic {Arsenii Iodidum, U. 8. and B. P.) is given in -£$ grain doses, 
and arseniate of sodium {8odii Arsenias, JJ. 8. and B. P.), in the dose 
of -fa to ^ of a grain. 

Acute Poisoning 1 . — Arsenic is a gastro-intestinal irritant, producing, 
when taken in poisonous dose, violent vomiting and purging, with 
great pain in the oesophagus, stomach, and entire belly. The passages 
are finally watery and resemble " rice-water " stools, but are to be 
separated from those of cholera and antimonial poisioniug by the 
presence of blood and, if necessary, by chemical analysis. The mucous 
membrane is stripped off the bowel and in the passages appears in 
shreds. Very commonly about the third day, if the patient survive so 
long, an intermission in the attack appears, which will only be followed 
by a return of all the symptoms, so that the physician must not give a 
favorable prognosis. In this symptom (remission) arsenical poisoning 
resembles phosphorus poisoning and yellow fever. Death generally 
occurs about the fourth or sixth day, and on or about the third day a 
peculiar skin eruption appears which may be of any character. In 
rare cases sudden pain, collapse, and death may take place after the 
ingestion of the poison. Widespread multiple neuritis may be brought 
on. A typical change always present in acute poisoning when it lasts 
for any length of time is fatty degeneration of all the tissues. 

Treatment of Acute Poisoning. — Besides washing out the 
stomach by the stomach-pump, applying external heat and stimulants, 
the proper antidotes should be at once employed, and the only ones of 
any value are the freshly-precipitated hyd rated sesquioxide of iron and 
magnesia. (See below.) The first is to be prepared by the precipita- 
tion of iron from one of its fluid preparations by the use of an alkali. 
Ammonia added to the tincture of the chloride of iron is efficacious, 
but the precipitate has to be repeatedly washed to rid it of an excess 
of this irritant. Magnesia is a better precipitant because it not only 
precipitates the iron but is an antidote itself. Monsel's solution and 
the so-called dialyzed iron may be employed in place of the tincture, 
but the Monsel's salt is too irritating and the dialyzed iron is so readily 
precipitated that it needs no alkali, but may be given pure. Magnesia 
is a useful antidote when used alone. 

Under the name Ferri Oxidum Hydration cum Magnesia the U. 8. 
P. recognizes an antidote for arsenic ; this is often called the " anti- 
dotum arsenici." The U. 8. P. directs that this antidote should be 
kept on hand for immediate use in the following manner : Mix 13J 
fluidrachms of the official solution of the tersulphate of iron {Liquor 



ASAFCETIDA. 81 

Ferri Tersulphatis) with 4J ounces of water and keep the mixture in 
a well-stoppered bottle. Rub 150 grains of magnesia with a little 
water to a smooth and thin mixture ; transfer it to a bottle capable of 
holding 32 ounces and fill the bottle with water. When the antidote 
is to be used add the magnesia solution slowly to the iron solution 
and shake together until a homogeneous mass results. 

After the use of the antidote opium should be used to allay irritation 
and pain, and large draughts of water be given to flush the kidneys 
and dilute the poison. In the later stages the danger from arsenical 
poisoning arises from the changes produced in vital organs. 

Chronic Poisoning by arsenic shows itself in great irritation of the 
air-passages, in diseases of the kidneys, in pigmentation of the skin, 
and in nervous symptoms due to inflammations of the nervous tissues 
in different parts of the system, such as patches of anaesthesia and local- 
ized loss of motor power. These anaesthetic areas are generally con- 
fined to the extremities, and extend only to the first or the second 
joint above. Arsenic often produces asthma in those exposed to it by 
reason of the irritation it causes in the bronchial tubes. Chronic 
poisoning is to be treated by withdrawal from the exposure, and the 
use of iodide of potassium to aid in the elimination of the arsenic. 
The other symptoms are to be treated by the application of electricity, 
tonics, out-of-door life, and such measures as will improve the general 
condition of the patient. 



ASAFCETIDA. 

Asafoetida, U. 8. and E. P., is a gum obtained by making an inci- 
sion into the root of the Ferula Nartliex. It occurs in irregular 
masses of a dark yellow or reddish color which become still more 
red if exposed to the light and air. Asafoetida in tears is a term 
applied to the drug when it appears in the shape of drops or pearls, 
and is a form seldom seen. Its odor is penetrating and strong, and 
resembles that of garlic. When taken internally it causes a sensation 
of warmth and acts as a stimulant and carminative in the alimentary 
canal. 

Therapeutics. — Asafoetida is used in medicine as a carminative 
which will particularly affect the lower bowel, and is useful in the 
intestinal indigestion of old persons when associated with flatulence, 
and in the flatulent colic of children. By way of rectal injections it 
is of value in the tympanites of children and in that of adults during 
typhoid fever. It is also used as a stimulating expectorant in the later 
stages of bronchitis. In the nervous irritability of children it is often 
of service. 

Administration. — Asafoetida is given in pills of asafoetida {Pilulo3 
Asafostidce, U. 8.), of which two or three may be taken, each one 
containing 3 grains ; the mixture or milk of asafoetida {Mistura Asa- 
foetidoB, TJ. &), the dose of which is J- to 1 ounce ; and the tincture 
(Tinctura Asafostidce, U. 8. and B. P.), J to 1 fluidrachm. The sup- 

6 



82 DRUGS. 

positories contain what is equal to 40 drops of the tincture ; and the 
plaster of asafoetida (Emplastrum Asafoetidee, U. 8.) is used where a 
faint counter-irritant and antispasmodic is ueeded. When intestinal 
indigestion and flatulence occurs in old people the following pill is of 

service : 

R . — Extracti nucis vomicae . . . . . gr. v. 

Extracti physostigmatis . . . . gr. iij. 

Asafoetidee gr. xl M. 

Ft. in pil. no. xx. S. — One night and morning. 

The B. P. preparations not official in the U. 8. P. are Enema 
Asafoetidee and Pilula Asafoetidee Composita, composed of asafoetida, 
galbanum, and myrrh, dose 5 to 15 grains. 



ASPIDIUM. 

Aspidium, U. $., Filix Mas, B. P., or Male Fern, is employed in 
medicine as a tseniacide or remedy against the tape-worm, and is a very 
efficient and valuable drug under such circumstances, being, perhaps, 
the most reliable of all the vermifuges except pelletierin. When em- 
ployed the directions and precautions given in the article on Worms 
must be strictly followed. 

Administration. — Male fern is rarely, if ever, used at present in its 
crude form, being employed most commonly in this country in the 
form of the oleoresin ( Oleoresina Aspidii,U. 8.), dose J to 1 fluidrachm 
in capsules, or as follows : 

R . — Oleoresin. aspidii "I -wi i 

Tinct. vanilhe } * ' ' ■ aa ^ xlv ' 
Pulv. acacise . . . . . . . gss. 

Aq. destillat f gj. M. 

S. — Take entire amount after fasting, and follow in two hours by a full dose of 
castor oil or sulphate of magnesium. 

The dose of the liquid extract (Extraction Filicis Liquidum) of the 
B. P. is 15 minims to 1 fluidrachm. 



AZEDARACH. 

Azedarach, U. 8., is the bark of the Melia Azedarach, or Pride of 
China, as it is sometimes called. It is found in Syria, Persia, the 
north of India, and in the southern United States. 

The drug has little toxic power, and children may eat of it largely 
without ill effect. If very large amounts are used gastro-intestinal 
inflammation occurs. It is employed as a remedy against the round- 
worm, and should be given in decoction made by boiling 2 ounces of 
the drug in a pint and a half of water until there only remains a pint 
of liquid. Of this from 1 to 2 tablespoonfuls are to be given a child, 
and repeated every two hours until the bowels are opened. It has 
also been used as a fluid extract prepared by the ordinary means with 



BAKIUM CHLOKIDE. 83 

alcohol, to which some white sugar should be added. The dose of this 

extract is a teaspoonful, and is not to be repeated. The decoction is 
the best form in which to use the drug. 



BARIUM CHLORIDE. 

One of the most recent and one of the best evidences of the value 
of the study of the action of drugs upon the lower animals is given 
us by this substance. It will be remembered that Brunton and 
Ringer, of London ; Kobert and Bary, of Dorpat ; and Bartholow 
and the writer in America, have at various times published, during 
the last few years, studies concerning the effect of barium on the cir- 
culatory apparatus of the frog, dog, and man, and all of them are in 
accord in the statement that it slows the heart very greatly, steadies 
its rhythm, and, at the same time, increases the volume of blood 
thrown out of the ventricle. They have also found that barium in- 
creases blood-pressure, and Kobert has, by a series of careful experi- 
ments, concluded that it brings about this change by an action on the 
muscular coats of the bloodvessels. 

If large doses are used in the lower animals, the heart suffers sys- 
tolic arrest from over-stimulation, and the strongest irritation of the 
vagus nerves fails to relax the systolic contraction. Still more inter- e 
esting is the statement that this failure of the vagi to inhibit the heart 
is not the result of paralysis of these nerves, but is simply due to the 
excess of cardiac contractile power. The slowing of the pulse is not 
due to inhibitory influence, but depends solely upon the stimulation 
of the heart muscle, although it would seem probable that the vaso- 
motor stimulation, by increasing the arterial resistance, may be at least 
a factor in the reduction of the pulse-rate. At one time, in the dog, 
after large doses, there is a period of increase of pulse-rate which is 
asserted to be due to stimulation of the accelerator nerves. 

In most works on chemistry barium is stated to be an irritant 
poison, but to produce such evidences of its presence the dose given 
must be extremely large, and many times greater than any amount 
useful for medicinal purposes. 

Therapeutics. — Barium chloride may be used in all forms of cardiac 
disease in which failure of the heart muscle is present. In the treat- 
ment of varicose veins it is said to be of value, both when given 
internally and applied locally over the distended vessels. 

A point worthy of remark is the character of the pulse-wave pro- 
duced. While its volume is increased it does not give that sensation 
of tenseness to the finger that does digitalis, and the pulse-wave seems 
to be very considerably prolonged ; a fact that the sphygmograph also 
records. 

Administration. — The solution of barium chloride to be used inter- 
nally should have the strength of 5 grains to the ounce of water, and 
of this 1 or 2 teaspoonfuls is to be given three times a day. 



84 DRUGS, 



BELLADONNA. 

Belladonna is botanically known as Atropa Belladonna, and is 
official in the form of the root (Belladonna Badix, U. 8. and B. P.), 
and leaves (Belladonna Folia, U. 8. and B. P.). It belongs to a very 
large class of plants which all have a similar physiological action. 
Belladonna contains an active principle in the form of an alkaloid, 
known as atropine (Atropina, U. 8. and B. P.), which is insoluble in 
water. The sulphate of atropine (Atropina Sulphas, U. 8. and P.P.) 
is soluble. 

Physiological Effects. — In man, full medicinal doses produce flush- 
ing of the face, redness and dryness of the fauces, dilated pupils, some- 
times an erythematous rash over the skin, rarely diplopia and delirium. 
If the dose be still larger the delirium becomes very marked and is 
wild and talkative. The pulse is rapid and wiry. The rash which 
appears resembles that of scarlet fever, but lacks the punctations. 
The skin may desquamate after several days if the rash is severe. 

In children belladonna is usually borne very well indeed, and 
opium very badly. When belladonna asserts itself in children the 
respiration is quickened, the eyes become bright and the cheeks red, 
but lines of pallor reach from the malar bones to the corners of the 
mouth, giving the face a curious expression. 

Nervous System. — Belladonna acts as a powerful excitant of the 
brain and spinal cord. 

When very large doses are given, paralysis of the spinal cord comes 
on, which is followed by tetanic spasms and finally by recovery. 
The primary loss of power is due to paralysis of the entire cord, and 
the second state, of convulsions, to the escape of the motor and sensory 
pathways from the paralysis before the inhibitory centres recover. 
As a result any peripheral irritation causes violent explosions of 
motor power. 1 Even in large medicinal dose belladonna may be con- 
sidered as a depressant to the motor nerves and as a quieter to sensory 
nerve-filaments. On voluntary muscles the drug has no effect, but 
upon unstriped muscles it acts as a depressant and antispasmodic. It 
distinctly lessens reflex action. 

Circulation. — Belladonna quickens the pulse by depression of 
the peripheral vagi and by stimulating the cardiac muscle. It pro- 
duces a rise of arterial pressure by stimulating the vasomotor centre 
and by the increased heart action which it causes. In poisonous doses 
it causes a fall of arterial pressure due to centric vasomotor palsy, 
and depression of the muscular coats of the bloodvessels, but not to 
cardiac depression, as has been generally taught, for Reichert has 

1 If a homely simile, found useful by the writer in teaching, may be used, the in- 
hibitory centres may be represented by a schoolmaster, and the motor and sensory 
centres by two boys. The escape of chloroform in the room paralyzes them all, but, 
finally, the boys recover before their master and go off as truants (convulsions) ; at 
last the master (inhibitory centres) recovers, and order, or health, is restored. 



BELLADONNA. 85 

proved that the drug is not a heart depressant unless the dose is simply 
overwhelming. Sometimes when belladonna is given the pulse be- 
comes slow, but in these cases the slowing is due to temporary stimu- 
lation of the peripheral vagi or to momentary depression of the cardiac 
motor ganglia. 

Respiration. — Atropine is a stimulaut to the respiratory centre 
in ordinary amounts, but recent careful studies show that its high 
reputation as a respiratory stimulant is not based either on clinical or 
experimental experience. In many cases it fails to increase the 
respiration at all, and it is certainly inferior to coffee and strychnine 
in the treatment of opium poisoning. In large doses it is a depressant 
and paralyzant to respiration, and produces death from respiratory 
failure due to paralysis of the motor nerves supplying the respiratory 
muscles, and probably by depressing the respiratory centres. 

Abdominal Contents. — Belladonna increases peristalsis by de- 
pressing the peripheral ends of the inhibitory fibres of the splanchnic 
nerves and by diminishing any tendency to spasm on the part of the 
muscular coats of the intestine. 

Action on Seceetion. — The drug decreases all the secretions of the 
body except the urine, which is sometimes increased in amount under 
its use. The decrease of secretion is due to paralysis of the peripheral 
nerve-filaments supplying the secretory cells of the glands. 

Bodily Heat. — When belladonna is used in large amounts there 
is nearly always a rise of temperature, which in children may amount to 
one or two degrees. In advanced poisoning the temperature rapidly 
falls. 

Elimination. — Atropine is eliminated by the kidneys and bowels 
and is partly destroyed in the liver. In a suspected case of poisoning 
the urine of the patient may be dropped in the eye of an animal, and, 
if atropine or belladonna has been taken, mydriasis will result. 

Eye. — On the eye belladonna produces dilatation of the pupil by 
stimulating peripherally the sympathetic nerve fibres of the iris and 
paralyzing the ocular motor fibres, but the dominant action of the drug 
is undoubtedly exercised upon the muscular fibres of the iris. It gen- 
erally increases intra-ocular tension. 

Treatment op Poisoning. — -Poisoning by belladonna is to be 
treated by the application of external heat if the patient goes into 
collapse and the use of strychnine if respiration fails. Opium may be 
employed in carefully graded doses as the physiological antagonist, but 
large doses are of doubtful service, particularly if the respirations are 
not in a satisfactory state. 

Therapeutics. — Belladonna is used to allay excessive secretion, to act 
as an antispasmodic, and to influence the circulatory apparatus when 
local inflammations are beginning, particularly in secretory glands. In 
cardiac palpitation small doses of belladonna internally, or its ex- 
ternal use over the praecordium in the form of a belladonna plaster or 
ointment, is very useful. It is also our most useful vasomotor stimu- 
lant in shock. Belladonna is of value in neuralgias and in the pains 
due to irritated peripheral nerves. 



86 DRUGS. 

To check secretion in night-sweats it is one of the best remedies we 
have, and it is useful in excessive idiopathic ptyalism, as seen in chil- 
dren, or in that due to mercurialization. In bromidrosis of the feet and 
other localized sweatings it is useful, and may be employed locally or 
taken interually for their cure. It is the best drug we have for check- 
ing the secretion of milk in au inflamed breast, and under these circum- 
stances it is best to smear it over the gland in au ointment. Bella- 
donna may be used in serous diarrhoea, as it checks the disorder by 
stimulation of the splanchnic vasomotor filaments of the intestinal 
bloodvessels, which being inactive permit a transudation of liquid into 
the bowel. 

Trousseau recommended as a local remedy 1 to 2 grains of the ex- 
tract of belladonna with 6 to 8 grains of tannic acid in leucorrhoea 
dependent upon disease of the uterine cervix. This should be placed 
on a pledget of cottou and applied to the affected part daily, being 
allowed to remain all day. Ringer states that if pain is also present 
in these cases the following injection is of value : 

H. — Sodii bicarbonatis gj. 

Tr. belladonnse f 3 ij. 

Aquae dest q. s. ad Oj. M. 

This is to be injected into the vagina, the woman first being placed on 
her back with her buttocks raised, so that the drug may bathe the 
uterine cervix for some minutes. 

As an antispasmodic, atropine is to be used in torticollis, injected 
directly into the muscle itself, so as to act on its motor nerve fibres, 
and it may be given in spasm of the intestine with cramps and griping, 
while in cramps in the legs and body, either as a local application by 
means of liniments, or when employed internally, it is of service 
In asthma of the spasmodic type, belladonna is a sovereign remedy, 
particularly if it be combined with morphine. It may be used both as 
a prophylactic and as a cure during the attack. The belladonna leaves 
may be smoked by rolling them into a cigarette or putting them into 
a pipe. 

This drug is used in whooping-cough at all ages and in all stages, 
but it has generally to be given in large amounts in this disease to do 
any good. 

In spasm of the sphincter ani, either that which is idiopathic or due to 
fissure, belladonna in the form of an ointment or suppository is of value. 
In spasm of the urethra and bladder the drug may be used internally 
and externally, and in the former state the ointment should be smeared 
along the under surface of the penis every night. This treatment is 
also useful in chordee. In the colic resulting from the passage of hepatic 
and renal calculi belladonna in full dose will nearly always give relief. 
Where urinary incontinence depends upon spasm of the bladder bella- 
donna should be used (see Urinary Incontinence). In dysmenorrhea in 
nervous women with spasm of the cervix uteri it is of very great value 
applied as an ointment or in a vaginal suppository, or when given by 
the mouth. For the nervous cough of children and adults belladonna 



BELLADONNA. 87 

is one of the best remedies we have. In constipation it does good by 
depressing the inhibitory nerves of the intestine. It is also of value in 
laryngismus stridulus and in hiccough. In spasms from peripheral irri- 
tations belladonna is of value. In iritis atropine is used to dilate the 
pupil and prevent adhesions. The solution to be dropped into the eye 
should contain 1 to 4 grains of atropine sulphate to the ounce of water. 
Atropine sulphate is also used for the purpose of producing mydriasis 
before ophthalmoscopic examination in solutions of the strength just 
given. It increases intra-ocular tension and is contra-indicated in 
glaucoma. When employed to act on the circulation it is to be used 
in shock and collapse from injury, or in the course of severe disease 
(see Shock). During the progress of a case of pneumonia, typhoid 
fever, or other severe disease, belladonna should be kept in the house 
and administered freely if collapse or vasomotor relaxation suddenly 
asserts itself. In mastitis, or inflammation of the breast, even where pus 
is beginning to be formed, belladonna, if pushed, will give surprisingly 
good results if given internally and applied locally. In sore-throat, 
when the pharynx is hot and dry and has a sensation of rawness, 
while the local capillaries appear injected and red, belladonna is often 
of the greatest service if given in full dose, aborting the u cold." 
In exophthalmic goitre belladonna is thought to act by stimulating the 
sympathetic nerves, and certainly gives relief in some cases. For the 
relief of local nerve pains it is of value, and probably acts by quieting the 
irritated nerve. It should be applied in these cases in the form of an 
ointment or plaster and be well rubbed into the part affected. 

In headache occurring in young persons, often due to over-work, 
with pain in the eyeballs and forehead and a sensation as if the orbits 
were too small for the eyeballs, belladonna is of service. In intercostal 
neuralgia or pleurodynia belladonna plasters may be applied to the 
spot where the pain is felt, with relief. 

Use of Atropine in Poisoning. — Atropine acts as an antidote in 
cases where poisonous mushrooms have been eaten, and is a physio- 
logical antidote to opium, Calabar bean or physostigma, and jaborandi. 
In opium poisoning it acts as an antidote in all parts of the body except 
the eye, and in jaborandi poisoning the same fact holds true. In opium 
poisoning the drug should not be given after the respirations rise to ten 
from three or four per minute, as too much of the drug may be given 
and atropine poisoning may come on and complicate the case. The 
condition of the pupil is not a guide as to the effect of atropine in opium 
poisoning, because opium acts centrically and atropine acts peripherally 
on the nerves governing the iris. Atropine should be used in aconite, 
antimony, and hydrocyanic acid poisoning, for its influence on the 
vasomotor system, the respiratory centre, and the heart, and for the 
purpose of maintaining the bodily heat, the dissipation of which it 
retards by preventing vasomotor palsy and consequent dilatation of 
the peripheral bloodvessels. It should be borne in mind that atropine 
is not the very best single antagonist to opium, and that it always 
should be largely replaced by caffeine and strychnine. 



88 DRUGS. 

Administration. — The dose of the sulphate of atropine (Atropince 
Sulphas, 77. 8. and B. P.), is yj-g- to -j^ of a grain. The alcoholic 
extract (Extr actum Belladonnce Alcoholicum, U. 8. and B. P.) is given 
in \ to J grain doses, and the tincture (Tinctura Belladonnce, U. 8. 
and B. P.) in the dose of 5 to 15 minims. The fluid extract (Ex- 
tr actum Belladonnce Fluidum, U. 8.) is given in 1 to 2 minim doses, 
while the extract of the B. P. is given in \ to 1 minim doses. Ab- 
stractum Belladonnce, U. 8., is given in the dose of 1 grain, and Succus 
Belladonnce, B. P., is given in 5 to 15 minim doses. The preparations 
of the B. P. not official in the U. 8. P. are Liquor Atropince Sulphatis, 
given in the dose of 1 to 6 minims, Lamellce Atropince, each of which 
contains 5--0V0" °^ a g ra i n of atropine, and Unguentum Atropince. 
Belladonna liniment (Linimentum Belladonnce, U. 8. and B. P.), 
Belladonna plaster (Emplastrum Belladonnce, U. 8. and B. P), and 
the ointment (Unguentum Belladonnce, U. 8. and B. P.) are for 
external application. 

Recent experiments show that belladonna decreases gastric secretion 
very considerably in some persons. It is better, therefore, not to 
administer it just before or immediately after a meal. 



BENZOATE OF BISMUTH. 

This is a preparation which has been highly recommended in 
Germany, and to some extent in this country within the last few 
years, in the treatment of chancroid. Under its influence the sore 
heals up with great rapidity and leaves a comparatively small cicatrix. 
It may also be used in the treatment of all specific sores and for the 
dressing of indolent or sloughing ulcers. Benzoate of bismuth, when 
properly applied, should be preceded by a careful washing of the 
diseased surface with a very weak bichloride solution, after which the 
bismuth is to be sprinkled over the wound and the entire surface 
covered with cotton, which should be held in place by an adhesive 
strip. The only disadvantage in this dressing lies in the fact that it 
has to be changed once or twice in every twenty-four hours. Im- 
mediately after it is applied it may produce some tingling or burning, 
but this is never very severe. 



BENZOIN AND BENZOIC ACID. 

Benzoin (Benzoinum, U. 8. and B. P.) is a resinous balsam derived 
from the Styrax Benzoin, which is a native of Sumatra, Borneo, and 
Java. Benzoic acid is obtained by the sublimation of gum benzoin, 
and it is benzoic acid which is generally used in medicine. 

Physiological Action. — Locally applied in concentrated form ben- 
zoic acid is an irritant, and taken internally in excessive amount it 
causes a sensation of warmth and burning. It is eliminated as hip- 



BICARBONATE OF SODIUM. 89 

puric acid, and increases the acidity of the urine. On the lower forms 
of life it acts as an antiseptic and germicide. 

Therapeutics. — Benzoic acid is useful in the treatment of chronic 
cystitis with alkaline urine which is loaded with phosphates, and, com- 
bined with cannabis indica, acts well in the later stages of gonorrhoea. 
Senator states that in the dose of 2 or 3 drachms a day it is a specific 
in acute rheumatism, and thinks it equal to salicylic acid. When these 
doses are to be used the benzoate of sodium should be employed, owing 
to its solubility. In acute laryngitis accompanied by great hoarseness 
the inhalation of steam laden with compound tincture of benzoin is of 
the greatest service. A tablespoonful of this tincture should be placed 
in a pitcher of boiling water, the face held over the liquid, and a 
towel thrown over the head of the patient to retain the steam. The 
drug cannot be used in an atomizer, as it clogs the " tips/' Taken 
internally it is useful in chronic bronchitis. 

Administration. — The dose of benzoic acid (Acidum Benzoicum, 
U. 8. and B. P.) is usually 10 to 40 grains, but a drachm may be 
given in capsule. The gum itself is never used as such. The tincture 
(Tinctura Benzoini, U 8.) is given in 30 minim to 1 drachm doses, 
and the compound tincture (Tinctura Benzoini Compositce, U. 8. and 
B. P.) is composed of benzoin, aloes, storax, balsam of Tolu, and 
alcohol, the dose of it being 1 to 2 fluidrachms. The preparations 
official in the B. P. but not in the U.S. P. are the troches (Trochisei 
Acidi Benzoici and Unguentum Cetacei). 

Adeps Benzoinatus ( U. 8. and B. P.), or benzoated lard, is simply 
a non-rancid basis for many ointments, notably that of zinc. 



BICARBONATE OP POTASSIUM. 

This salt (Potassii Bicarbonas, U. 8. and B. P.) is used for the 
same purposes as the citrate and acetate of potassium, and as it is 
much less agreeable in taste should not be employed when they can be 
obtained. From the bicarbonate of potassium are made several very 
useful preparations : the liquor potassii citratis, by adding 960 grains 
to 720 grains of citric acid and 24 ounces of water ; the neutral mix- 
ture, by adding to 1 pint of lemon-juice enough of the potassium salt 
to neutralize it. The dose of potassii bicarbonas is 5 to 40 grains, or 
even as much as 2 drachms may be given if well diluted with water. 



BICARBONATE OP SODIUM. 

Bicarbonate of Sodium (Sodii Bicarbonas, U. S. and B. P.) is a 
salt largely used as an antacid in gastric fermentation, and in sick head- 
aches, arising from this condition. Combined with calomel in powder 
it certainly adds to its efficiency in increasing biliary flow, as all 
alkalies of this class liquefy and thin the bile. The drug has been 
widely employed in the treatment of rheumatism, and is found to be 



90 DRUGS. 

of great service in allaying pain and soreness in the joints when used 
in a lotion made by dissolving it in water and applying it to the part 
on lint or rags. In acidity of the stomach the following effervescing 
powder is useful : Bicarbonate of sodium (Sodii Bicarbonas), 30 grains 
in one paper, and, in the other, 20 grains of tartaric acid (Acidum 
Tartaricum). These are each dissolved in half a tumbler of water, 
added to one another, and swallowed during effervescence. 



BISMUTH. 

Bismuth (Bismuthum, B. P.) is official as the subcarbonate (Bis- 
muthi Subcarbonas, U. $.), the subnitrate (Bismuthi Subnitras U. #., 
and B. P.), the citrate {Bismuthi Citras, U. S. and B. P ), and the 
bismuth and ammonium citrate (Bismuthi et Ammonii Citras, U. S. 
and B. P.). The first and second are identical in their dose (5 to 20 
grains) and action, and may be employed interchangeably. The 
third and fourth are more astringent and more irritating than the 
other two, and must be given in a smaller dose, which is 2 to 4 
grains. Many years ago the drug was supposed to be capable of 
producing gastro-enteritis in large doses, but this was due to a con- 
tamination by arsenic. Bismuth may produce chronic poisoning after 
prolonged use on wounds or when internally administered. The 
changes under these circumstances are the formation of black sloughs 
in the mouth and gastro-intestinal tract, desquamative nephritis, and 
albuminuria. The preparations of the B. P. not official in the 
U. S. P. are the Liquor Bismuthi et Ammonii Citratis, dose J to 1 
fluidrachm, and the troches (Trochisci Bismuthi), 2 grains in each. 
Bismuthi Carbonas, B. P., is the same as the subcarbonate of the 
U. 8. P. 

Therapeutics. — Bismuth is used as an astringent in large doses to 
cover the surface of inflamed mucous membranes and so to allay irrita- 
tion. It is useful in irritative vomiting for this reason, and in diarrhoza 
of a similar type in which the stools are serous. If the passages are 
mucous, castor oil should precede bismuth in order to rid the ali- 
mentary canal of the secretion already poured out. It is very useful 
when combined with carbolic acid in serous diarrhoea, given in cap- 
sules containing 5 grains of bismuth subnitrate and 1 drop of carbolic 
acid (Wood). It is also to be used as a slow and feeble antacid. The 
Bismuthi et Ammonii Citras is very astringent, and should be used in 
chronic serous diarrhoeas in the dose of 5 grains every two or three 
hours. The other preparations of bismuth are insoluble, and they 
should not be given in water, but this preparation is soluble, and may 
be given in solution. Bismuth is of service in dyspepsia when lactic 
and butyric acid fermentation is present with excessive belching, and 
may be employed in gastralgia and gastric ulcer and gastritis as a 
sedative and astringent. Bismuth and ammonium citrate must never 
be employed if acute inflammation exists. 

When the salts of bismuth are used for any length of time they 



BITARTRATE OF POTASSIUM. 91 

cause the odor of garlic to appear in the breath, which is due to the 
presence of an exceedingly slight trace of tellurium in the bismuth. 
The stools are apt to become black, and the tongue, if furred, may 
also be black about the centre when bismuth is used. 

Where there is chapping of the hands or cheeks from exposure to 
cold or wet, the following prescription is useful : 

R. — Bismuthi subnitratis - . . . . giij. 

Zinci oleatis . giij. 

Lycopodii 3 ij. M. 

S. — Apply to the parts t. d. 



BISMUTH SALICYLATE. 

(See Salicylate of Bismuth.) 

BISMUTH SUB-GALLATE. 

Dermatol or the sub-gallate of bismuth was first used by Heinz 
and Liebrecht. It is a fine yellow powder which is unaffected by 
long exposure to light and air, and is entirely odorless. Its uses are 
identical with the external uses of iodoform, and it probably acts in 
much the same manner as does the latter drug, namely, by so drying 
the wound that it becomes an unfavorable soil for the growth of germs. 
As dermatol is an astringent it cannot be employed in the treatment 
of indolent ulcers which need stimulation rather than an astringent 
influence, and it would seem probable on theoretical grounds, that it 
is not to be compared to iodoform in the treatment of cases in which 
tubercular processes are going on. 

There is no doubt that dermatol is less poisonous than iodoform, 
but it must be capable of producing some untoward effects if used 
profusely for any length of time, since poisoning follows the pro- 
longed employment of bismuth preparations, as has been determined 
by Balzer, Dalche, and Yillejean, for the symptoms of which see the 
article on Bismuth. 

Dermatol may be tried in cases of skin disease in which there is 
much secretion, as in weeping eczemas and similar states, either in the 
form of a dusting powder or in an ointment with vaseline or lanolin 
in the proportion of J to 1 drachm to the ounce. Sometimes its 
efficiency can be much increased by the addition of equal parts of 
oxide of zinc to the prescription just given. 

Dermatol has been used in cases of purulent otitis media and many 
states requiring similar effects with marked success. 



BITARTRATE OP POTASSIUM. 

Potassii Bitartras, U. S., Potassii Tartras Adda, B. P., is some- 
times called " cream of tartar," or acid tartrate of potassium. It is a 



92 DKUGS. 

white gritty powder which may occur in rhombic crystals. Owing to 
its stability it has been thought that it escaped from the body without 
oxidation, aud so to differ from the other potassium salts formed from 
vegetable acids. This is probably incorrect. 

Therapeutics. — The bitartrate of potassium is the most diuretic of 
the potassium salts, and is used in chronic nephritis with gin or com- 
pound infusion of juniper, when it is very useful in removing dropsy. 
One ounce of the salt is added to a pint of the infusion of juniper 
berries, and the entire quantity taken in divided doses in twenty-four 
hours. In acute renal disease the drug should be used without the 
juniper. In large doses (half an ounce) it acts as a watery purge, but 
is rarely so used. Where the urine is thick and alkaline bitartrate of 
potassium is a useful remedy to neutralize it and make it clear and 
normal in hue. 

BORAX AND BORIC ACID. 

Borax, or Sodii Boras ( U. S. and B. P.), may be made by the action 
of boracic or boric acid upon soda, but the drug as it appears in 
commerce in America is derived entirely from natural deposits found 
on the shores of lakes in California and Nevada. The natural product 
is, of course, very impure, and has to be purified before it is market- 
able. Borax is soluble in twelve times its weight of water. Both 
borax and boric acid have been supposed to act as efficient germicides in 
strong solutions, but this has been proved incorrect. They are anti- 
septics, however, even when in weak solutions. In the form of a lotion 
boric acid has been used as a remedy for erysipelas with a good deal 
of success, and it may be similarly employed in burns and scalds. 
Borax may also be used as a wash in diphtheria and in aphthous stoma- 
titis, cancrum oris, and gangrenous stomatitis. Internally borax has 
been used in epilepsy, and may be tried with some slight hope of a 
good result. In the treatment of pruritus ani and vulva?, and in 
bromidrosis and foetid sweating it is of great value when used as a wash. 
Strong solutions locally applied are useful in tinea tonsurans and tinea 
circinata. Boric acid may be given internally in cystitis to render the 
urine acid, and is useful in the removal of freckles when applied as a 
wash to the skin. 

Borax should not be used with glycerin, as an acid reaction is apt 
to occur. 

Boric acid is one of the most commonly used substances in eye- 
washes, either alone or with cocaine. When used with cocaine or other 
drugs it is employed to prevent the destruction of the alkaloid or 
glucoside, as the case may be, by the growth of mould. 

The following formula may be employed : 

R. — Cocain. hydrochlor. .... gr. iv vel viij. 

Acid, boric. - gr. x vel xx. 

Aquse destillat f^ij- M. 

S. — To be used in conjunctivitis and similar states. 



BRAYERA. 93 

Boroglycerin is a liquid made by mixing 62 parts of boric acid with 
92 parts of glycerin in a tarred porcelain capsule, at a temperature of 
not more than 302° F. The acid is added to the glycerin gradually, 
with constant stirring. When the mixture has been reduced to the 
weight of 100 parts it is poured on a flat surface, wet slightly with 
petroleum, and on hardening is cut into blocks, which should be placed 
at once in a well-stoppered bottle. When used for medicinal purposes 
the glycerite of boroglycerin should be employed, which may be made 
by adding 1 ounce of the boroglycerin in solid form to 1 ounce of 
glycerin and heating in a dish while stirring. It is soluble in water. 
Locally the glycerite of boroglycerin is used as an antiseptic, and as a 
vehicle for carbolic acid, chrysarobin, and the vegetable alkaloids in 
the treatment of skin diseases and in diseases of the eye, such as 
purulent ophthalmia. 

The following makes a very elegant application for the skin of the 
face and hands : 



B • — Acid, boric. 



si- 



Cerse albse 3j. 

Paraffini gij. 

01. amygdalae dulc. . . . . . . f^ij. M. 

S. — To be thoroughly mixed and applied night and morning. 

Potter recommends the following in uric acid diathesis when there 
is a tendency to the formation of stone : 

B . — Magnesii carbonatis 3 j. 

Acid, citrici ^ij- 

Sodii borat . ,^ij. 

Aquse bullientis . . . . . . f§viij. M. 

S. — A tablespoonful t. d. 

Or, 

B .—Acid, boric 3J. 

Potassi bitartrat % iv. 

Aquse q. s. ad f^x. M. 

S. — Heat together to dryness, and give 20 grains in water, well diluted, t d. 

Borated lint is made by dipping lint into a boiling, saturated solu- 
tion of boric acid or borax. It makes a simple, inexpensive anti- 
septic surgical dressing, and contains nearly one-half its weight of 
the drug. Glycerinum Boracis, B. P., and Mel Boracis^ B. P., are 
not official in the U. 8. P., but are used as local applications for 
chapped hands and small sores. 



BRAYERA. 

Brayera, V. 8., Cusso, B. P., sometimes called Kousso, is derived 
from Brayera Anthelmintica, a plant of Abyssinia. It contains a vola- 
tile oil, tannic acid, and koosin or tseniin. The drug is used against 
the tape- worm, and is most valuable as a vermifuge, also possessing 
the advantage of safety. It should be used in an infusion (Infusum 



94 DRUGS. 

Brayerce, U. 8. P.) in the dose of \ an ounce of the powdered flowers 
to a pint of water, and be taken in the morning on an empty stomach. 
(See Worms.) Koosin may be used in the dose of 20 to 40 grains in 
capsule. The fluid extract (Extractum Brayerce Fluidum) is given in 
the dose of J an ounce. It has been said that the drug is apt to cause 
abortion in pregnant women, but this is not known to be a fact. In- 
fusum Cusso, B. P., is given in the dose of 4 to 8 fluidounces. 



BROMIDES. 

Bromides of potassium, sodium, lithium, calcium, gold, nickel and 
ammonium, and hydrobromic acid. 

Bromide of Potassium. 

Bromide of potassium (Potassii Bromidum, U. S. and B. P.) is the 
most commonly used and important member of the group above 
named, and will, therefore, be spoken of before the others. 

It is prepared by precipitating freshly-made bromide of iron with 
pure carbonate of potassium, or by a process more readily carried out 
and recommended by the B. P. It occurs in colorless transparent 
crystals which are stable in dry air, but absorb moisture in a damp 
atmosphere. It is very soluble in water, but less so in alcohol. 
This bromide has a salty taste, and is distinctly irritant to mucous 
membranes if locally applied in concentrated form. 

Physiological Action. — Bromide of potassium has an action upon 
the animal economy which is clearly defined and closely followed by 
all the other bromide salts, so that what is said in this place concerning 
its effects may be taken as representing the whole class of bromides, 
except in the instances where slight differences exist, which will be 
pointed out under the various names of the respective salts. 

Nervous System. — The bromide of potassium acts as a distinct 
depressant to the motor and intellectual portions of the cortex cerebri. 
It slows the development of thought and decreases the excitability 
and power of the motor cells of the brain. (Albertoni.) Upou the 
spinal cord it acts as a marked sedative, affecting chiefly the sensory 
tracts, and causing thereby loss of reflex action and a decrease in 
the ability of the animal to recognize pain. It also depresses to a 
less extent the motor pathways in the cord. Motion is maintained 
after sensations to pain and reflexes are lost. The drug depresses 
the peripheral parts of the sensory nerves, and, in very large doses, 
the motor nerves and muscles are similarly involved. 

Circulation. — If the drug be injected in ordinary dose into the 
jugular vein it causes at once a fall of arterial pressure and pulse-rate. 
These changes are due to a direct action of the bromine and the 
potassium upon the heart. When given to man in therapeutic doses 
by the mouth its circulatory effect is so slight as not to be worthy of 
consideration. 



BROMIDE OF POTASSIUM. 95 

Respiration. — Bromide of potassium is a depressant to the respir- 
atory centre in toxic dose. In medicinal dose it does not affect the 
breathing except when the amounts given are large and the drug 
persistently administered, when the breathing becomes slower. 

Temperature. — No effect upon this function is noted, unless the 
dose be enormous ; when such a dose is given the bodily heat is pro- 
gressively diminished, the fall of temperature being probably due to 
the circulatory and nervous depression produced, associated with the 
general failure in vital power. 

Elimination. — The drug escapes unchanged very slowly with all 
the secretions, and is found in the sweat, urine, tears, semen, milk, 
and faeces. 

Tissue-waste is decreased. 

Therapeutics. — From what has been already said it is evident that 
bromide of potassium is a remedy to be devoted almost entirely to the 
treatment of diseases of the nervous system, and its uses are, therefore, 
as various as the manifestations of perversion of nervous action can 
be various. In a word, it may be said that bromide of potassium is 
to be used wherever over-excitement of nervous protoplasm is present, 
but never where nervous symptoms are due to depression. 

In epilepsy, which, to the best of our knowledge, is due to explosive 
impulses arising in the cerebral cortex, it is the best drug we have, 
and in all forms of minor spasm, due to heightened reflex activity, it 
is of service. In spasmodic contractions, in the treatment of hysterical 
females, in nervous startings and alarm at sudden noises in adults and 
children, and in the nervous symptoms accompanying pregnancy and 
the menopause, it will be found of great value. The following pre- 
scription is recommended very highly by Goodell, and will be found 
of service in these states : 

R. — Ammonii bromidi %ij. 

Potassii bromidi . . . . . 3 iv. 

Spts. ammon. aromat . f.^vj. 

Aquse camphorse . . . . q. s. ad f^vj. M. 

S. — A dessertspoonful to a tablespoonful every four hours. 

In headaches due to uterine trouble the pain is often felt at the top 
of the skull or at the back of the neck near the occiput. The cause 
of this trouble will sometimes be found to be in the cervix uteri, and 
relief under these circumstances can only be obtained when the uterus 
is treated and the bromides administered. 

In convulsions in children and adults, combined with chloral, bro- 
mides are most efficient, and are sometimes of service in incontinence 
of urine due to vesical spasm. In seminal emissions due to a morbid 
excitability of the centres in the spinal cord, bromide of potassium is 
one of the best remedies we have, and in satyriasis and nymphomania 
it is of great service. 

In cases where undue irritability of the pharynx and larynx prevents 
examination of these parts, one or two full doses will render an exami- 
nation easy of performance by decreasing the local reflex activity. 



96 DRUGS. 

This is a useful point to be remembered in relation to the treatment 
of pharyngeal and laryngeal disease. 

In cases of acute laryngitis full doses of the bromides (60 to 120 
grains a day) are very useful. 

The bromides are found to be of service in the laryngeal crises of 
locomotor ataxia, the explanation of this fact being as follows : The 
adductor centre of the larynx is situated in the brain, and the abductor 
centre in the spinal cord. The first closes the larynx, the second 
opens it, and in health they maintain a patulous tube by their oppo- 
sition. In disease the spinal centre (the abductor or opener) fails, 
and the adductor in the brain being unopposed, produces closure of 
the tube with disastrous results. The bromide, by quieting reflex 
action, as well as depressing the adductor centre in the cerebral cortex, 
prevents this accident. 

In whooping-cough with much mucous exudation the drug is rarely 
of benefit and had better not be used. In laryngismus stridulus or 
any form of spasm depending upon local irritation, the local trouble 
must, of course, be removed if possible. In teething the drug may be 
used to decrease reflex irritation and prevent convulsions, and it will 
decrease the night- screaming of children — which is often due to bad 
dreams — to a very extraordinary degree, even if the dose be quite 
small. As a soporific for the insane, and in the insomnia of the over- 
worked and that of nervous women, the bromide of potassium is of 
great service. It may also be employed with good results in chronic 
alcoholism and morphiomania. In migraine and neuralgia due to eye- 
strain or other nerve strain, combined with caffeine the bromide is 
almost a specific. The caffeine seems to stimulate the depressed nerve 
up to the normal level, and the bromide to deaden the perception of 
the pain. The following is a most valuable remedy in migraine and 
even in sick headache. It ought not to be used in bilious headache, 
which will often be made worse by it : 

R . — Antipyrini gr. xxv. 

Caffeinse citratis . . . . . gr. x. 

Potassii bromidi . . . . . gr. xxv. M. 

Ft. in chart no. v. S. — One powder as needed. 

In the treatment of dysmenorrhoea and menorrhagia, particularly in 
young subjects, the bromides are also of service (see Dr. Goodell's 
prescription just given.) When the flow is too great at such a period the 
drug should be begun a week before the expected epoch, and kept up 
in the dose of 5 to 10 grains night and morning. In cases where the 
epochs follow one another too closely the drug should be used con- 
tinuously. After an apparent cure ensues the bromide should be used 
for a few periods to avoid a relapse. For sea-sickness the bromides 
are the best prophylactics we possess, and should be used in the close 
of 5 to 10 grains three times a day for several days before the patient 
sails in order to quiet the vomiting centre. After sea-sickness begins 
they should not be given in ordinary solution, but in an effervescing 
draught made as follows : 



BROMIDE OF AMMONIUM. 97 

R. — Acid, citric. gij. 

Aquae dest f J iv. M. 

Ft. sol. 

Be. — Potassii bromidi . . . . . • 3J- 
Potassii bicarbonatis . . . . gj. 

Aquse dest f ^ iv. M. 

Ft. sol. S. — A tablespoonful of each of these solutions should be added to one 
another and taken during effervescence. 

This prescription will also be found of value in the persistent vom- 
iting of pregnancy and in that following prolonged etherization, or 
other states. If the vomiting is excessive the dose ought to be re- 
duced to 2 teaspoonfuls of each solution and be given every half-hour 
until half of each mixture is taken or the patient is relieved. In 
cases where this will not act, rectal injections of the following will be 
found of value : 

R . — Potassii bromidi gr. xxx. 

Tinct. opii deodorat. . . . . . . gtt. xxx. 

Aquae amyli f^ v j- M- 

S. — To be injected gently into the empty rectum and retained as long as possible. 

This method is the most reliable plan that can be followed. 

Bromide of potassium may be used to prevent the symptoms of 
cinchonism after quinine and salicylic acid, and it is said to prevent the 
nausea and depression so apt to follow the use of opium. 

Administration. — The dose of bromide of potassium is from 5 to 120 
grains a day. 

Use of Bromides in Poisoning". — Bromides are useful in all con- 
vulsive attacks consequent upon the ingestion of poisons, except those 
due to cardiac sedatives which depress the circulation at the base of the 
brain ; and they may be used to allay any nervous symptoms which 
are of an excited nature, to prevent excessive vomiting, to produce 
sleep, and to quiet delirium, and even to allay pain. 

Effects of Prolonged Use. — After the drug has been used for some 
time acne appears about the face and extends over the entire body, 
the breath becomes foetid, the patient dull, expressionless, and heavy, 
remaining buried in sleep during nearly every hour of the day. 
During this time he can be aroused, but at once falls to sleep again. 
The walk becomes weak and feeble, the movements slow and pain- 
fully prolonged Taste is lost and hearing is benumbed, while the 
intellectual faculties of the brain are almost blank. Loss of sexual 
power is an early symptom. The acne may be put aside by the use 
of arsenic, and where bromides are used to any extent in women this 
drug should always be given simultaneously to prevent the eruption. 
As Fowler's solution is compatible with the bromide in solution, it is 
the best form of arsenic to employ. 

Bromide of Ammonium. 

Bromide of Anmionium (Ammonii Bromidum, U. S. and B. P.). 
This salt is far more stimulating than the bromide of potassium, and 

7 



98 DRUGS. 

it is certainly much more irritating. The dose is about the same as the 
potassium salt — 5 to 60 grains a day. Combined with antipyrine it 
is useful in epilepsy. Da Costa has recommended it highly in rheu- 
matism in large doses well diluted, but the author has never seen it 
do any good in such cases. 



Bromide of Calcium. 

Calcium Bromide (Calcii Bromidum, U. S.) was introduced into 
medicine as a nervous sedative and hypnotic, and was thought at one 
time to be an efficient substitute for the bromide of potassium. Its 
action on the nervous system is virtually identical with that of the 
potassium salt, and it has been found to be far less irritant and depres- 
sant than the latter. For some unknown reason it has never won the 
confidence of the profession, but it may be given with very good results 
in the dose of from 30 to 90 grains a day, or even more in cases which 
are not readily affected by bromides. It is employed especially in 
hysteria and epilepsy, and in all the conditions in which the other 
bromide salts are indicated. It is sometimes of value combined with 
the potassium salt, since under such circumstances better results are 
often gained than if a single salt is employed. 

Bromide of Gold. 

The bromide of gold has been employed in epilepsy by a number 
of clinicians with great success in the dose of from ^ to J grain three 
times a day in pills. Physiological studies have proved that the drug 
is a direct sedative to the motor cells in the cortex cerebri. 

Bromide of Lithium. 

Bromide of Lithium (Lithii Bromidum, U. 8.). This salt is much 
weaker than the other salts, and may be given in larger dose. Dr. S. 
Weir Mitchell states that it is of value in epilepsy after the potassium 
salt fails. The dose is 30 to 90 grains a day. 

Bromide of Nickel. 

This is a green salt quite irritant to the stomach. The author has 
made an experimental study of the bromide of nickel and found it prac- 
tically identical with the bromide of potassium in physiological action. 
It should be given well diluted, or in an effervescing draught, as it is apt 
to disorder the stomach if used in concentrated solution. The efferves- 
cing form of the drug is made by mixing the salt with bicarbonate of 
sodium and tartaric acid, moistening with alcohol, passing the moist 
powder through a sieve, and then drying it in a warm closet. 



OR BRYONY. 99 



Bromide of Sodium. 

Bromide of Sodium (Sodii Bromidum, U. S. and B. P.). This salt 
is to be used in every instance where bromide of potassium can be 
employed. Its dose is the same, although it is asserted to be a little 
weaker physiologically, grain for grain, than the potassium salt. It is 
far less apt to disorder the stomach, and is not so generally depressant 
as is the bromide of potassium. 

Hydrobromic Acid. 

Hydrobromic Acid is an extremely irritant preparation, but is 
thought to be less apt to cause acne and other untoward effects than 
the other bromides. It is only to be used in the form of the official 
dilute acid (Acidum Hydrobromicum Dilutum, U. S. and B. P.) aud to 
be given in the dose of from one drachm to half an ounce well diluted 
with sweetened water. It is highly recommended by De Schweinitz 
and others for headaches due to eye-strain in nervous women. 



BROMIDE OP ETHYL. 

(See Ethyl Bromide.) 

BROMIDE OP STRONTIUM. 

(See Strontium.) 

BROMINE. 

Bromine (Z7. S. and B. P.) is a dark-red liquid of an excessively 
pungent odor like that of chlorine, possessing very extraordinary 
power as a caustic when applied to the tissues of the body. It is the 
most severe caustic we possess, and penetrates very deeply. It may 
be applied in hospital gangrene and other large sloughs, by means of 
a glass-rod. 

BRYONIA, or BRYONY. 

This is a remedy very largely used by irregular physicians but 
which nevertheless possesses very great power and often relieves con- 
ditions which are obstinately persistent under other treatment. It is 
the root of Bryonia Alba or Bryonia Dioica ( U. S.). The only official 
preparation is the tincture (Tindura Bryonia?, U.S.). The dose of 
the powdered root as a drastic is 10 to 40 grains. 

Physiological Action. — In overdoses bryonia acts as a hydragogue 
cathartic and gastro-intestinal irritant. On serous membranes it 



100 DRUGS. 

exercises an irritant influence and may produce symptoms of meningitis 
wheu given in poisonous doses. In moderate doses bryonia may 
cause some flushing of the face and neck and headache in susceptible 
persons. The drug needs studying from a physiological point of view. 

Therapeutics. — Although one of the oldest of remedies, bryonia has 
been given a new impetus by the homoeopaths, who employ it in a 
number of affections. In the treatment of dyspepsia depending upon 
gastric and intestinal atony or the abuse of alcohol or other similar 
causes, bryonia often gives relief. Its influence is exerted through 
the irritant effects it produces, for by this means it stimulates or spurs 
the atonic digestive glands to increased activity. For this reason it 
has been found to be particularly useful in children who suffer from 
constipation resulting from insufficient secretion on the part of 
the intestinal glands. When the passages are dry and friable and 
resemble those of a dog in character, bryonia is of great value. 
The drug has been praised as a remedy in the treatment of rheu- 
matism and in pleurisy, but little is recorded as to its real value 
in these diseases. It is probably always more effective when the 
febrile stages of these affections have passed by. Thus in pleurisy 
it is useless during the acute, forming stage, but prevents the pouring 
out of effusions, and if they be already poured out aids in their 
absorption. 

Administration. — The dose of the tincture of bryonia is from 1 to 
2 fluidrachms as a laxative, but the so-called mother tincture of the 
homoeopaths is perhaps the best preparation for ordinary use. The 
proper amount to be used in the treatment of a case of dyspepsia is 
from 5 to 40 drops unless the mucous membranes are very torpid, 
when this quantity may be increased. In pleurisy with effusion 
drastic doses may be needed, but the saline purgatives are safer and 
more efficacious. 

BUOHU. 

Buchu ( U. S.) is derived from Barosma Betulina, a plant of Africa. 
It contains a volatile oil, which is probably the active principle, and 
a bitter extractive. It is official, under the name of Buchu Folia, in 
the B. P. 

Therapeutics. — Buchu is used as a diuretic when it is desired to 
affect the mucous membranes of the genito-urinary tract which are 
chronically diseased, and particularly when these parts are below 
their normal tone. It does not increase the urinary flow to any 
great extent, but acts on the genito-urinary passages as a stimulant. 
It is useful in 'pyelitis, cystitis, and vesical irritation of a chronic type. 
The following prescription is useful : 

R . — Potassii citratis 3 iv. 

Spt. chloroformi f ^iij. 

Tinct. digitalis - . f gj. 

Infusi buchu f % viii. M. 

S. — Two tablespoonfuls three times a day. 



CAFFEA. 101 

If the urine is continually highly acid, muddy, laden with salts, 
and productive of incontinence by reason of the vesical irritation 
which it produces, buchu iu the form of the fluid extract, in the dose 
of a teaspoonful three times a day, combined with an equal amount 
of sweet spirit of nitre, will be of great service. For a child the 
dose of the fluid extract should be about ten to thirty minims. If 
the vesical irritation is acute buchu is contra-indicated. 

Administration. — The fluid extract (Extractum Buchu Fluidum, 
U. 8.) is the only official preparation, and it should be always well 
diluted before it is given, in the dose, to an adult, of 1 drachm three 
times a day. The infusion is not official, but is made by adding one 
ounce of the leaves to a pint of water. The dose of this is a table- 
spoonful to two tablespoonfuls. The official B. P. preparations are 
the infusion (Infusum Buchu), dose 1 to 4 fluidounces, and the tincture 
(Tinctura Buchu), dose 1 to 2 fluidrachms. 

OAOTUS GRANDIFLORUS. 

This is a plant of Mexico and the West Indies. There are other 
species possessing medicinal power, but the Cactus grandiflorus is the 
most active. 

The drug is best given in the form of the tincture or the fluid extract. 

Physiological Action. — This has been studied by Myers, and Boinet 
and Teissier, who have found that the drug causes a distinct increase 
of arterial pressure, but does not slow the pulse, sometimes increasing 
its rapidity. Myers has also shown that the drug is a stimulant to 
the vasomotor centres and to the motor ganglia of the heart muscle. 
Cactus grandiflora also acts as a stimulaut rather than a depressant to 
the spinal cord. 

Therapeutics. — Cactus grandiflorus bids fair to prove itself a good 
substitute for digitalis in certain diseases of the circulatory apparatus 
such as cardiac palpitation and weakness. It has also been found 
very serviceable as a remedy in cardiac failure the result of valvular 
disease. Cactus also acts well in some cases of angina pectoris. 

Administration. — The dose of the tincture of cactus is 2 to 8 minims 
and of the fluid extract 2 to 4 minims. 

Untoward Effects. — It is claimed that these do not occur, and that 
the drug never produces a cumulative effect. 

CAFFEA. 

Caffeine (Cafeina, U. 8. and B. P.) is an alkaloid derived from 
the berries of Caffea Arabica, which also contain, upon roasting, an 
empyreumatic oil. Caffeine is usually employed in medicine as the 
citrate, and is soluble in 75 parts of water. 1 

1 Theine, derived from tea, caffeine, the active principle of coffee, and the alkaloid 
of guarana from South America, are chemically identical. Much of the caffeine of 
commerce is really theine, although it is claimed that pure theine has a very different 
physiological action. 



102 DRUGS. 

Physiological Action. — On the nervous system caffeine acts as a 
rapidly acting stimulant, exerting its chief influence on the brain 
and spinal cord. By its cerebral effect it causes increased rapidity 
of thought, and by its influence on the spinal cord it increases 
reflex activity, and for this reason is said to make people " nervous/' 
It is important to remember that it has no effect on brain protoplasm 
except to stimulate it, and that ultimately a brain driven along by 
caffeine breaks down by the concentration of its energy for the time 
being in one effort. In the frog in poisonous doses it causes tetanic 
convulsions by an action on the spinal cord, and if applied directly 
to a muscle, causes it to contract spastically. It does not affect the 
motor nerves. 

Circulation. — Caffeine has been supposed to increase the pulse- 
rate and blood-pressure by stimulating the heart muscle, but from 
recent studies in this country and abroad it would seem probable that 
these changes are indirectly produced and due solely to its stimulating 
action on the nervous system. Clinically, it certainly seems to raise 
the blood-pressure in almost every instance where it is used. 

Kidneys, Tissue-waste, and Elimination. — Caffeine increases 
diuresis by a direct stimulation of the secretory epithelium of the 
kidney, and therefore increases the amount of solids as well as of the 
liquids in the urine. Upon tissue-waste the drug acts as a depressant, 
and is therefore a conservator of the tissues. It is burnt up in the 
body. 

The empyreumatic oil, of which there is about one-half to one tea- 
spoonful in each well-made breakfast cup of coffee, has no physiological 
effects. It is probably the cause of the "biliousness" sometimes pro- 
duced by the habitual use of coffee, due to the faulty digestion of this 
oil, which is also apt to disorder the digestion if taken alone. 

Therapeutics. — Caffeine is a valuable cardiac stimulant and tonic 
as well as a renal stimulant. It acts equally well in cardiac and renal 
dropsies for this reason, and is an invaluable remedy in such cases. In 
acute renal inflammation it is contra-indicated, because all stimulants 
are contra-indicated in acute inflammations. In opium poisoning, 
owing to its stimulant effect on the respiratory centre, it is very 
valuable. Under these circumstances it may be given in the form of 
strong black coffee, which will aid in keeping the patient awake and 
also add heat to the body, which is often very cold. A cup of strong 
black coffee is often useful in the treatment of a paroxysm of asthma. 
In headache due to nerve-strain, caffeine combined with antipyrine 
and one of the bromides is of the greatest service (see Neuralgia). So 
useful is caffeine in cases of cardiac disease that it has largely sup- 
planted digitalis in the hands of some practitioners. 

Caffeinw, U. S. and B. P., cannot be used hypodermically, owing 
to its decomposition in the presence of water. The following solution 
may, however, be used hypodermically : Salicylate of sodium, 30 parts ; 
caffeine, 40 parts ; and distilled water, 60 parts ; or, in other instances, 
the following preparation, recommended by Huchard, may be em- 
ployed : Benzoate of sodium, 45 grains ; caffeine, 30 grains ; distilled 



CALCIUM. 103 

water, 1| drachms. This mixture is to be heated and 10 drops given 

at a dose. 

t 

CAJUPUT OIL. 

Oil of Cajuput (Oleum Cajuputi, U. 8. and B. P.) is a volatile oil 
distilled from Melaleuca Cajuputi, a tree of the Molucca Islands. It 
is a stimulant, and in large amounts an irritant, to mucous mem- 
branes, but acts as an efficient carminative and parasiticide in 
moderate amounts. As a remedy for tinea tonsurans and pediculi it 
should be applied pure to the part affected. Cajuput oil is capable of 
irritating the skin. In diarrhoea of a serous type it is of value in 
the dose of 10 to 20 drops (see Diarrhoea). Spiritus Cajuputi is 
official in the B. P. ; dose, J to 1 nuidrachm. 



CALCIUM. 

Calcium is official in a number of forms, and is to be distinctly 
separated in the mind of the student from calx or lime, which is an 
oxide of calcium. It is never employed as calcium, but as one of its 
salts. These are as follows : Bromide of calcium ( Calcii Bromidum, 
U. 8.), precipitated carbonate of calcium (Calcii Carbonas Precipitatus, 
U. 8., Calcii Carbonas Precipitata, B. P.), chloride of calcium (Calcii 
Chloridum, U. 8. and B. P.), hypophosphite of calcium (Calcii Hypo- 
phosphis, U. 8. and B. P.), and as precipitated phosphate of calcium 
(Calcii Phosphas Precipitatus, U. 8., Calcii Phosphas Precipitata, 
B. P.). Calcium sulphate is not official. 

All salts of calcium are incompatible with acids. 

The precipitated carbonate of calcium is used in the treatment of 
serous diarrhoea, as an antacid and as a local protective in cases of 
chapped skin or intertrigo, particularly in young children. When 
given internally the dose is from 10 to 30 grains, but by far the best 
method for its administration is in the employment of chalk mixture 
(Mistura Cretan, U. 8. and B. P.), which contains about 30 grains of 
the chalk to each ounce of liquid. The dose of this mixture is from 
a teaspoonful for a young child to an ounce for an adult. In the 
treatment of cases of diarrhoea chalk mixture is best given in com- 
bination with tincture of kino or the compound tincture of catechu 
and paregoric, in some such form as follows : 

R.— Tr. kino . . . ' . . . . fgj. 

Tr. catechu comp. f.^ij; 

Misturse cretae . . ■ . . q. s. ad f^vj. M. 
S. — A dessertspoonful every three hours till diarrhoea ceases. 

It is to be remembered that the chalk mixture acts very slightly as 
an astringent, and chiefly as an antacid and mechanical agent in the 
alimentary canal. 

Precipitated carbonate of calcium is the slowest antacid which we 
possess, and for this reason is the remedy to be employed in acidity of 



104 DRUGS. 

the intestines, as it passes through the stomach to a very great extent 
unchanged. (For the varieties of diarrhoea in which it is to be used 
see article ou Diarrhoea.) As an external application it is used in 
sweating, of the feet and hands, and sometimes as a dry dressing to 
ulcers. It may also be used over burns. 

Calcium chloride, when taken internally in any amount, acts as an 
intense gastro-intestinal irritant, and may produce death by this means. 
It is to be distinctly separated from the chlorinate or chloride of lime, 
with which it is sometimes confused, for the latter is nothing more 
than hydrate of lime or slacked lime, containing 25 per cent, of chlo- 
rine, while chloride of calcium is a hard, vitreous, friable substance, 
giving off no odor of chlorine and utterly different in its use, action, 
and appearance. 

Chloride of calcium is used in medicine by some physicians in the 
treatment of scrofulous enlargements of glands in the neck and else- 
where, and is even said to cause calcification and encysting of tuber- 
cular nodules. In cases where deficient bone-formation is evident it 
often does good, but the other salts of lime, such as the lactophos- 
phates, are better. In cases where boils mature slowly, a poultice made 
by adding a solution of chloride of calcium to the mass may be used 
to hasten suppuration. The dose internally is 5 to 30 grains, best 
given in a solution made by adding water in the proportion of a 
drachm to each 5 grains of the drug. 

The hypophosphite of calcium and the precipitated phosphate of 
calcium are used for the treatment of scrofulosis or strumous states 
and allied conditions such as rachitis, geuerally in the form of the 
Syrupus Hypophosphitum, U. S., and the Syrupus Calcii Lactophos- 
phatis, U. 8. 

The large amount of phosphate of calcium in the bones and tissues 
renders it a useful drug when the body is starved of its proper 
proportions of salts, and its use has been found, in animals, to cause 
a great increase in bony growth, not only in the earthy but also in the 
animal constituents of the osseous tissues. The hypophosphite has a 
similar effect. 

In rickets and in fractures where the bone is slow in uniting, and 
in some cases of phthisis and scrofula, the lactophosphates and hypo- 
phosphites are of service. In dental caries, particularly that occur- 
ring in nursing women, and in the anosmia of this class of patients, 
they are useful. In general debility and nervous prostration they are 
often of great value, and may be even used with benefit in chronic and 
atonic diseases of the skin and mucous membranes. In cases of hepatic 
torpor they may be employed with advantage. 

The lactophosphates are better than the hypophosphites, as the latter 
are probably changed into phosphates in the stomach as soon as they 
enter the viscus. The only advantage which they possess over phos- 
phorus in certain diseases, particularly of the bony system, is that they 
afford an easy method of administration, and also that they contain 
calcium. The dose of either of these two drugs is 10 to 30 grains 
three times a day, or, of the syrups just named, a teaspoonful to a 



CALUMBA. 105 

tablespoonful. The difference between these salts and phosphorus, 
both in therapeutical effect and physiological action, is to be clearly 
borne in mind. The lactophosphates and hypophosphites are simply 
convenient modes of administering calcium, potassium, or other sub- 
stances, while phosphorus acts as a stimulant to bone growth and not 
by its deposition in the bone. Phosphoric acid does not act any more 
like phosphorus than does sulphuric acid act like sulphur. 

Sulphate of calcium is not to be confounded with sulphide of cal- 
cium, or, to speak more correctly, calx sulphurata. Very often failure 
attends the use of this remedy, because the calx sulphurata has 
undergone oxidation and is calx sulphate. (See Boils and Calx.) 

Chalk is a native calcium carbonate chiefly obtained from shells. 

Prepared chalk (Creta Preparata, U. S. and B. P.) is given in the 
dose of 20 to 60 grains. Other preparations are compound chalk 
powder (Pulvis Or eke Compositus, U. S.), dose 10 to 60 grains, and 
troches of chalk (Trochisci Cretce,U. S.). Preparations official in the 
B. P., but not in the U. 8. P., are aromatic powder of chalk (Pulvis 
Cretce Aromaticus), dose 10 to 60 grains, and Pulvis Cretce Aromaticus 
cum Opio, dose 10 to 60 grains. 



CALUMBA. 

Calumba, Columbo, or Columba, is the root of the Cocculus Palmatus, 
a climbing plant of Mozambique. Its taste is bitter, and its odor is 
slightly aromatic. Two alkaloids are found in it, berberine and colum- 
bine, and. a third substance known as columbic acid. Calumba is one 
of the purest bitters known 

Therapeutics. — Calumba is one of the best simple tonics which can 
be used, owing to its lack of astringent effect and to its favorable action 
on mucous membranes. 

In cases of g astro-intestinal atony, particularly that following fevers 
and similar states, calumba will be found of service, and it is a valu- 
able remedy in the convalescent stages of summer complaint and serous 
diarrhceas. The following prescription of Dr. George B. Wood is 
very useful in these states when they are associated with flatulence : 

R . — Calumba? pulv. . . . . . . ^ ss. 

Zingiberis pulv. . . . . . % ss. 

Sennse fol. . 3j. 

Aquse bullientis Oj. M. 

Ft. in infusum. S. — A wineglassful t. d. 

Administration. — The fluid extract (Extractum Calumbm Fluidum, 
U. S) is given in the dose of 15 to 60 minims ; the tincture (Tinctura 
Calumbce, U. S.), dose 1 to 4 fluidrachms. The dose of the extract 
(Extractum Calumbce, B. P.) is 2 to 10 grains; the infusion (Infu- 
sum Calumbce, B. P.) 1 to 2 fluidounces, and the tincture (Tinctura 
Calumbce, B. P.) \ to 2 fluidrachms. 



106 DRUGS. 



CALX. 



Calx, or Lime, or Oxide of Calcium, is an alkaline earth which is 
incompatible with acids, ammoniacal and metallic bases, borates, alka- 
line carbonates, and astringent vegetable infusions. 

Therapeutics. — Lime is used for the purpose of acting as an escha- 
rotic, particularly on old ulcers and on hairy growths. It is never 
given internally, except in the form of the hydrate or slaked lime. 
As an escharotic application lime is used in the official caustic Potassa 
cum Calce. When given internally it should always be used as Liquor 
Calcis, U. S. and B. P., or lime-water, and under these circumstances 
it acts as an antacid, as an aid to the digestion of milk by preventing 
too rapid and solid coagulation of the casein, and by exciting an 
increased gastric secretion. It is also feebly astringent. Given to 
infants and nursing women it, is probably utilized in the body in the 
formation of bone. It is also of value in diabetes, in the uric acid 
diathesis, and in the excessive nausea and vomiting very often seen in 
adults and children. Teaspoonful doses of milk aud lime-water, equal 
parts, will often be retained when nothing else will remain in the 
stomach. 

The dose of lime-water is a teaspoonful to 1 ounce or even 2 ounces. 
Externally applied, lime-water is of value in tinea capitis and similar 
states, and it is the best application in burns, when it is to be mixed 
with equal parts of linseed or olive oil, forming the Linimentum 
Calcis, U. S. and B. P., or carron oil. As a local application in mem- 
branous croup and diphtheria, lime-water has a high reputation and is 
believed to dissolve the membrane. It may be used as a spray or by 
means of a swab. 

Liquor Calcis, or lime-water, is to be made by adding a piece of 
unslaked lime as large as a walnut to 2 quarts of boiled and filtered 
water in an earthen jar ; after stirring it thoroughly allow it to settle, 
and pour off the clear liquid into a bottle. More water may then be 
added to the lime until it is all used. 

Sulphurated lime {Calx Sulphurata, U. S. and B. P.) is useful to 
check inflammation and hasten suppuration ; the dose is -^ of a grain. 
It is of value in acne pustulosa and all forms of suppuration in the 
skin. Where sulphurate of lime is not obtainable and successive crops 
of boils constantly appear, it is often possible to relieve the patient by 
baking egg-shells in an oven, powdering them, and then letting the 
patient eat 1 drachm or more of the powder each day. The prepa- 
rations of the B. P. that are not official in the U. S. are the saccha- 
rated solution of lime (Liquor Calcis Saccharatus), dose 15 to 60 
minims, and slaked lime (Calcii Hydras) used in different prepara- 
tions. 

OAMPHOR. 

Camphor [Camphor a, U. S. and B. P.) is derived from the Cin- 
namomum or Taurus Camphora, which grows chiefly in China and 



CAMPHOR. 107 

Japan. The camphor used in the drug stores is in reality refined 
camphor, and is so obtained by repeated sublimation. It is a volatile, 
irritant gum or resin, producing a burning taste and possessing a 
peculiar odor, soluble in one thousand parts of cold water and in one 
part of strong alcohol. Camphor is so volatile that if allowed to 
remain exposed to the air for any length of time it rapidly loses its 
bulk and eventually disappears. It is an exceedingly combustible 
substance, burning with a flame and much smoke. It may be white 
or pinkish in color. 

Physiological Action. — If taken in large amount camphor produces 
epileptiform convulsions preceded by vertigo, roaring in the ears, and 
delirium. The pulse soon becomes rapid, feeble, and running, and the 
skin livid, cold, and covered with sweat. Great heat and burning may 
be felt in the belly, and if the poisoning be slow, evidences of gastro- 
intestinal and renal inflammation ensue. In small doses it acts as a 
stimulant and adds a sensation of warmth to the stomach, while the 
pulse may become more rapid and stronger under its influence. At 
the same time there is a sedation of the nervous system and a general 
feeling of contentment. In large medicinal dose camphor is thought 
by some to act as a sexual stimulant and by others as a sexual sedative. 
The stimulant effect is probably only produced by doses large enough to 
produce irritation of the genito-urinary tract. The convulsions fol- 
lowing poisonous doses are cerebral in origin, and the drug, although 
largely destroyed in the body, is eliminated by the kidneys as campho- 
glycuric acid and escapes by the breath and perspiration. 

Therapeutics. Internal Use. — Camphor is employed for the pur- 
pose of acting as a nervous sedative and antispasmodic in the treatment of 
nervous women and children, and as a carminative in persons who suffer 
from intestinal flatulence. It is of value in nervous dysmenorrhea and 
headache, and is best combined with one of the new analgesics, such as 
antipyrine and acetanilide given in pill form. As it is virtually a 
volatile oil, so far as its physiological action is concerned, it will be 
found useful in cholera morbus and all forms of serous diarrhoea, but 
rarely in mucous diarrhoea (see Diarrhoea). In chordee, combined with 
bromides and similar depressants to the spinal cord, camphor is of 
great service in some cases, particularly late in the disease. In adynamic 
fevers it has been used as a diffusible stimulant by Graves and others 
with great success. Camphor is a very useful remedy in cases of sud- 
den nervous depression. It may be given by the mouth or, if the 
emergency is a pressing one, by hypodermic injection. Under these 
circumstances it is best given in the form of camphorated oil in the 
strength of 1 part of camphor to 9 of sweet oil, which last should be 
perfectly sterile. The dose of this solution is 15 minims. When 
used in the nervous depression of phthisis Alexander asserts that its 
continuous injection may result in cumulative action and develop the 
symptoms of mild camphor poisoning. In hiccough it is of great ser- 
vice, and in cardiac palpitation due to functional irritability it is 
found to be of value. In capillary bronchitis and catarrh of the air- 
passages it will be found useful in old or atonic cases. In chronic 



108 DRUGS. 

nasal catarrh spirits of camphor when inhaled from the neck of a 
vial gives oif enough of the drug to start up secretion and tone up 
the parts. It is also of value as a mouth-wash in persons who have 
foetid breath. 

External Use. — Externally camphor may be used as a stimulant 
to indolent sores, and as a useful addition in small amount to the pre- 
cipitated carbonate of calcium as a dusting powder in intertrigo. In 
the form of a liniment camphor is used over inflamed joints from sprains 
or rheumatism, and in myalgia and neuralgia to relieve the pain and 
stiffness. 

Camphor may be inhaled or taken internally in cases of cold in the 
head with great relief and a decided influence in aborting the attack. 
After the attack is in full force it is useless, but used early it will 
decrease the frontal headache and the sneezing and running at the nose. 
In coryza from unknown causes with much lachrymation and incessant 
sneezing, camphor will be found of benefit. It may be snuffed up the 
nostril in a fine powder, or powdered camphor may be put in boiling 
water and the fumes inhaled. The spirit may also be inhaled from a 
handkerchief. 

Camphorated alcohol, spirit of camphor, is a useful application for 
abortive purposes when used over boils, in their formative stage, if 
repeated two or three times a day, for a few moments at a time. Fol- 
lowing these applications the skin should be dried, and comphorated 
oil applied. Ringer and Tilt both recommend that Eau de Cologne, 
saturated with camphor, be rubbed into the head in the drowsiness and 
headache of the menopause, and a lotion of equal parts of aqua am- 
monia and spirit of camphor dabbed on the painful or hyperaesthesic 
spots at the top of the head, so commonly felt at the change of life or 
duriug menstruation, will be found to give relief. 

Administration. — Camphor is used internally in the form of the 
camphor water (Aqua Camphorce, TJ. 8. and B. P.), dose J to 2 fluid- 
ounces ; the spirit of camphor (Spiritus Camphoroe, TJ. 8. and B. P.), 
dose J a fluidrachm, or in the form of the camphor itself, in pill, in 
the dose of 1 to 3 grains in each pill. The best preparation for internal 
use is the spirit, or the camphor itself may be given in pill form. 

For external use we have, official, the Camphor Liniment (Lini- 
mentum Camphorm, TJ. 8. and B. P.), and the Soap Liniment, or Lini- 
mentum Saponis, TJ. 8. and B. P., which is the mildest of the two. 
Qeratum Qamphoro3 is also official. A compouud tincture of camphor 
(Tinctura Camphoro3 Composita), composed of opium, benzoic acid, 
camphor, and oil of anise, is official in the B. P., dose 15 minims to 
1 fluidrachm. Ldnimentum Camphoraz Compositum, B. P., is com- 
posed of camphor, rectified spirit, and stronger ammonia. 



CAMPHOR MONOBROMATE. 

Monobromate of Camphor (Oamphora Monobromata TJ. 8.). This 
drug is made by heating together in a sealed tube camphor and 



CAMPHORIC ACID. 109 

bromine. It occurs in colorless crystals or scales, and has a mild taste 
resembling camphor. It is almost entirely insoluble in water, but 
freely soluble in alcohol, ether, and chloroform. 

Physiological Action. — Monobromate of camphor possesses powers 
partaking of the bromides and of camphor. In the frog it causes loss 
of reflex action, motor palsy and death by respiratory failure, and in 
warm-blooded animals violent convulsions, Cheyne-Stokes respira- 
tions, muscular tremblings and weakness. The pulse is at first more 
rapid than normal, then slow and weak, death coming in coma or 
during the convulsions. 

Therapeutics. — Monobromated camphor will generally be found 
most useful in combination with other drugs in pain due to disease, 
such as lumbago, or that due to nervous disturbances. If used in 
hysterical females it will often produce sleep, and is of value to those 
who are addicted to the camphor-habit, as it acts as a hypnotic and 
warms the stomach. Like camphor itself, it is a gastric irritant, and 
should not be employed where gastritis exists. It has been used in 
spermatorrhoea with great success, and in delirium tremens has been 
found of benefit in cases where the gastric mucous membrane is de- 
pressed and the nervous tvvitchings are troublesome. In tvhooping- 
cough it may be tried, and it has even been used in chorea, epilepsy, and 
petit mal. In the nervous depression and pains of epidemic influenza 
monobromated camphor has been largely used. (See Acetanilide.) 

Administration. — It should never be used hypodermically, as it is 
too irritating, but administered in the dose of 5 grains three times a 
day in pill or in an emulsion made by dissolving it in six times its 
weight of expressed oil of almonds and then forming an emulsion with 
gum arable and water in the usual manner. 



CAMPHORIC ACID. 

Camphoric Acid is made by the oxidation of camphor through the 
influence of acids, and has been used in the night-sweats of phthisis 
with great success. In a large number of cases suffering from night- 
sweats the author has found this drug to act very favorably indeed 
where other remedies failed. 

It may be resorted to iu the dose of from 20 to 30 grains taken an 
hour or two before the sweat is expected. In very obstinate cases as 
much as 60 grains should be given, but under these circumstances it 
should be used in two separate doses of 30 grains each, two hours 
apart, in order to avoid irritating the stomach. It is best given in 
capsule, as it is insoluble in water. In other instances camphoric acid 
may be given in the following formula : 

Be . — Acid, camphoric 3 iv. 

Alcohol ffij : 

Mucilag. acacise f Jiij- 

Syr. aurantii corticis . . . q. s. ad f^vj. M. 
S. — Dessertspoonful to a tablespoonful one hour before sweat is expected. 



110 DRUGS. 

It is worthy of note that camphoric acid is possessed of little power, 
in the writer's experience, in cases of bromidrosis. 



CANNABIS INDICA. 

Indian Hemp {Cannabis Indica, V. S. and B. P.) is the flowering 
tops of Cannabis Sativa It is to be distinctly separated from the 
so-called American, American-Indian or Canada hemp, or Apocynum 
Cannabinum, which is an intense irritant and drastic. 

Physiological Action. — Given in full dose to man this drug causes 
exhilaration, and periods of constant laughter arising from the slightest 
cause, the person seeming convulsed with merriment ; in other cases 
the sensations are disagreeable, and even death may seem imminent to 
the deranged mind. Often the sensation of very full breathing comes 
on, and the patient thinks he is about to burst with the inflation of 
his lungs. After this deep sleep appears, lasting for many hours, 
even as much as fourteen or fifteen, without any intervals of wake- 
fulness. If the dose be very large the respirations are slowed very 
considerably, but no death from the use of cannabis indica by man is 
on record, and enormous amounts have been given to the lower ani- 
mals without causing a lethal effect. 1 Applied to mucous membrane it 
acts as a very severe irritant and then as a local anaesthetic, but the 
primary effect is so powerful as to prevent its local use for the relief 
of pain. 

One of the most constant and pressing symptoms in poisoning in 
man is the marked sensation of prolongation of time, so that minutes 
seem like hours, and, in addition to this, a peculiar separation of the 
mental powers occurs during which both hemispheres of the brain 
seem to think differently on the same subject. 

Therapeutics. — Cannabis indica is one of the best adjuncts to 
cough mixtures that we possess, as it quiets the tickling in the throat 
and yet does not constipate or depress the system as does morphine. 
In advanced phthisis it is justifiable to constantly keep the patient in 
a state of euthanasia by its use. For the relief of pain, particularly 
that depending on nerve disturbance, it is very valuable. Before the 
introduction of antipyrine and its congeners, tincture of gelsemium 
and the tincture or extract of cannabis indica were our best remedies 
in migraine. The gelsemium under such circumstances should be 
given in full dose, 20 drops of the tincture, and be followed by 10 
to 20 drops of the fluid extract of cannabis indica — it being known 
that the sample about to be used is active. After this dose of gel- 
semium the patient should be carefully watched least he suffer from 
an excessive influence of the drug, as such an amount may produce 
great depression in susceptible persons. In true migraine with 

1 The author has injected as much as 5 drachms of a fluid extract, active in the 
dose of 10 minims to man, into the jugular vein of a small dog without producing 
death for many hours. 



CANNABIS INDICA. Ill 

hemianopsia this treatment is often most effectual in aborting the 
attack. The prevention of further attacks is to be attained by the 
use of smaller amounts of the cannabis indica during the intervals ; 
the gelsemium only being used at the onset of the symptoms. In 
paralysis agitans cannabis indica may be used to quiet the tremors, 
and in spasm of. the bladder, due to cystitis or nervousness, it often 
gives great relief. In sexual impotence, not dependent upon organic 
disease, it is said to be of value combined with strychnine, or nux 
vomica, and ergot. When a patient suffers from sleeplessness which 
is due in part to pain and iu part to nervousness, the following pre- 
scription may be given : 

R.-Chloralis \ . 

Sodii bromidi / CfJ ' 

Ext. belladonnse fl. . . . . . . f gj. 

Ext. cannabis indicse fl. . . . . . f 3J. 

Syr. acacise f^vj. M. 

S. — Tablespoonful at a dose. 

In headaches at the menopause cannabis indica is useful, and, if 
the headaches are associated with constipation, iron and aloes should 
be given simultaneously, particularly if anaemia is present. Where 
headaches are due to retinal asthenopia a very useful prescription, 
according to De Schweinitz, is as follows : 

R. — Tr. nucis vomicae f ^ij. 

Tr. cannabis indicse f^ij. M. 

S. — Fifteen drops in water twice or tbrice a day. 

In whooping-cough and asthma cannabis indica sometimes proves of 
service. 

In uterine subinvolution, chronic inflammation and irritation can- 
nabis indica is of great value, and it has been found of service in 
metrorrhagia and nervous and spasmodic dysmenorrhea. Not only 
does it relieve the pain, but it seems to act favorably upon the muscu- 
lar fibres of the uterus. 

In acute and chronic BrigMs disease cannabis indica often allays 
the painful sensations over the renal region, and has been recom- 
mended by some writers in the cases in which bloody urine is present. 
In gonorrhoea it is said to decrease the discharge and prevent chordee, 
and it has supplanted the use of copaiba and cubebs in some practi- 
tioners' hands. It should not be used in the early stages of gonor- 
rhoea, but in the later or subacute stages. 

There is some foundation for the belief that in small doses it acts 
as a sexual stimulant. The advantages possessed by it are its lack of 
constipative power, and the fact that it does not cause after-depression 
and nausea, its happy effect in most cases, and an increase rather than 
a decrease of the appetite under its influence. 

Administration. — The employment of this most valuable remedy is 
handicapped by its frequent lack of power — a fault which is largely 
dependent upon its preparation. The drug as prepared by Parke, 
Davis & Co. and the solid extract of McKesson & Robbins have 



112 DRUGS. 

proved efficacious in the author's hands for a number of years. The 
physician should always employ some preparation known by him to 
be active by personal trial before condemning the drug as a failure in 
a given case. 

The dose of the solid extract (Extractum Cannabis Indicce, U. S. 
and B. P.) is from £ to J grain, that of the fluid extract {Extractum 
Cannabis Indicce Fluidum, U. S.) from 4 to 20 minims, and that of 
the tincture (Tinctura Cannabis Indicce, TJ. S. and B. P.) from 15 
minims to 1 drachm. 

OANTHARIS. 

Cantharis ( U. S. and B. P.), or " Spanish Fly," is really a beetle 
known as the Cantharis vesicatoria, and as such appears with iri- 
descent coverings or wing-sheaths of a bluish or greenish hue. They 
come chiefly from Spain, Italy, and Sicily, and from the southern 
parts of Russia. Those from Russia are supposed to be the best. 
According to Leidy, the vesicating substance is in the blood, the eggs, 
and the secretions of the generative apparatus. The blistering sub- 
stance contains cantharidin as an active principle, but cantharidin is 
not medicinally employed. 

Physiological Action. — The ingestion of a moderate dose of can- 
tharides produces only slight stimulation of the genito-urinary system, 
particularly the kidneys and urinary tracts. Large amounts produce 
great -pain in the lumbar region, burning in the bladder and entire 
urethra, priapism, agonizing vesical tenesmus, widespread acute ne- 
phritis, bloody urine, which is scanty at first and finally suppressed, 
with great irritation of the external openings of the genito-urinary 
apparatus. The inflammatory changes which are produced may cause 
sloughing of the penis or of the labia in the female. 

Violent gastro-enteritis is nearly always a pressing condition. A 
diagnostic sign of cantharidal poisoning, where the beetles have been 
swallowed, is the appearance of pieces of the iridescent wings and coats 
in the vomit. Thirst is always a prominent symptom of poisoning by 
cantharides. 

Therapeutics. — Cantharides are employed internally and externally. 
When given by the mouth the tincture is used as a uterine stimulant, 
to affect the uterine mucous membrane and relieve amenorrhcea in 
cases where atony and depression are the cause of the suppression. 
Some persons teach that the tincture of cantharides is a valuable 
remedy in small doses in the second stage of acute desquamative 
nephritis, but in the instances where the writer has seen it used it has 
made matters much worse, although it is supposed to decrease the quan- 
tity of the albumin and blood. In the later stages, where the kidneys 
are relaxed and torpid or where albuminuria comes on on the slightest 
exertion, cantharides in the dose of one drop of the tincture three 
times a day are of great service. 

In cases of chronic nephritis, particularly where alcoholism is the 
cause of the disease and the kidneys are inactive, cantharidal tincture 



CANTHARIS. 113 

is very useful. In pyelitis and in chronic cystitis it is of service, and 
it has been recommended very highly in drop doses in irritability of 
the bladder in women and children. In these cases the bladder must 
not be inflamed, but irritable from depression. The use of cantharides 
is of value in incontinence of urine of a minor degree, as that occur- 
ring in some elderly or nervous females when coughing, sneezing, or 
laughing, and will often prove of service after many years of suffer- 
ing. In chordee in the dose of one drop twice or thrice daily it is of 
service. For impotence depending upon sexual excess Ringer asserts 
that the use of 10 to 15 drops of the tincture of cantharides with full 
doses of the tincture of the chloride of iron and mix vomica will 
often relieve the patient and enable him to beget children. The drug 
has no true aphrodisiac influence except in toxic dose. In gleet of a 
very chronic type and in prostatorrhcea it is of service. Dermatolo- 
gists have used cantharides internally as a remedy in psoriasis, eczema, 
lichen, and prurigo, with asserted great success. The dose should be 
so small as not to irritate the stomach. 

The unofficial plasters of cantharides made by several firms are the 
best preparations to use for the production of a blister. In order to 
obtain a perfect effect the skin should be washed thoroughly with 
soap and water and dried with a towel, which should be rough enough 
to produce reddening of the cuticle. After this wet the skin with 
vinegar, and while wet apply the blister. 

Externally cantharides are used in the production of vesication for 
the purpose of withdrawing water from a small area, or as a counter- 
irritant of some severity in cases of deep-seated inflammations (see 
Counter-irritation). Care should be taken that a sufficient amount of 
the drug is not absorbed to cause strangury and renal irritation. 
In renal congestions and inflammations the use of cantharides as a 
counter-irritant is often contra-indicated for this reason. In the pro- 
portion of one drop of the tincture of cantharides to forty of water it 
is said to be a very good application for burns, but how it acts is not 
known. 

Administration. — The dose of the tincture (Tinctura Cantharidis, 
U. 8. and B. P.) is from 1 to 10 drops, and it is the only preparation 
used internally. The cerate (Ceratum Cantharidis, U. 8.) is used, 
spread upon a rag, to produce a blister, and the cerate of the extract 
{Ceratum Extracti Cantharidis, U. S.), is used for the same purposes 
and in the same manner. The cantharidal collodion (Collodium cum 
Cantharide, U. 8.) is a method of applying the blister^ which is most 
cleanly, but there is more danger of absorption of the irritant if it is 
used. The collodion acts as a protective to the part. The papers of 
cantharides (Charta Cantharidis, U. S. and B. P.) are used as blis- 
ters, but are weak in action. The liniment of cantharides (Linimentum 
Cantharidis, TJ. 8., Liquor Epispasticus, B. P.) is employed as a 
counter-irritant. 

" Warming plaster" (Emplastrum Picis cum Cantharide, U. 8.) is 
a mild counter-irritant to be employed where a blister is thought to 
be too severe. The preparations of the B. P., other than those named, 



114 DRUGS. 

are Acetum Cantharidis, Charta Epispastica, JEmplastrum Calefaciens, 
Emplastrum Cantharidis, and Unguentum Cantharidis. 



CAPSICUM. 

Capsicum, U.S., Capsici Fructus, B. P,, or Cayenne Pepper, is 
the fruit of Capsicum Fastigiatum, a native of tropical Africa and of 
Central America. It occurs in long ovoid pods which, when ripe, are 
scarlet red and possess a very hot, burning taste. The active principle 
is capsicin, which is a dark reddish liquid, or, in other words, is a 
volatile alkaloid. 

Physiological Action. — Locally applied to the skin or mucous mem- 
branes capsicum causes great redness, and, finally, in the case of mucous 
membranes, vesication. The alkaloid will also produce these changes 
in the skin. When used internally for any length of time in excess 
capicum will cause a chronic or subacute gastritis with pain and dis- 
comfort over the liver and stomach. If single large doses are used 
renal irritation and inflammation ensue, with strangury and high- 
colored urine. Taken internally, capsicum is said to act as a circu- 
latory stimulant. 

Therapeutics. — In cases of atony of the stomach due to general 
debility, errors in diet, and alcoholism of the chronic type, capsicum 
is one of the best remedies we have. In cases of acute alcoholism the 
gastric mucous membrane is often too much irritated to permit of its 
use, but after the lapse of some days it may be found of benefit to 
increase the appetite. As a remedy for subacute alcoholism it is quite 
useful, since by its stimulating effect and hot sensation it often satisfies, 
at least to some degree, the craving for liquor. Under these circum- 
stances it should be used in the dose of 5 to 10 drops of the tincture 
every four or five hours, or as the oleoresin in pill in the dose of J to 
1 grain. The following prescription has been found of great service 
in the wards under the writer's charge at St. Agnes's Hospital in 
these cases : 

R. — Tr. capsici fgijss. 

Tr. opii deodorat. f gij. 

Spt. aether, nitrosi f 3 iv. 

Spt. lavandulge . . . . q. s. ad f ;§iv. M. 
S. — Dessertspoonful every four or five hours. 

In the flatulent colic of old persons and young adults capsicum will be 
found not only to act as a carminative but also to prevent the develop- 
ment of the gas. In low fevers it has been used as a diffusible stimulant, 
but it is of doubtful value. It is rather in the anorexia of convalescence 
that capsicum acts most favorably. In chronic nephritis it is of consid- 
erable service and it tends to check albuminuria, but it is only to be used 
in the chronic forms and stages of renal disease or in the treatment of 
functional torpidity of the kidney. The tincture is to be given under 
these circumstances in the dose of 20 drops or less, but in some cases 
which are very chronic, as much as 40 drops may be used. In sore- 



CARBOLIC ACID. 115 

throat and simple tonsillitis the tincture of capsicum and glycerin, half 
and half, are very useful as a local application applied by means of a 
swab. The same preparation may be used as a gargle for relaxed uvula 
and sore-throat Applied externally capsicum acts as a counter-irri- 
tant, producing redness of the skin, but not a blister in the ordinary 
individual. It is one of the best moderate counter-irritants which can 
be used, and it may be employed by saturating blotting-paper, time 
and time again, in the tincture of capsicum, allowing it to dry between 
each dip. This paper should finally be placed when warm and wet 
over the part and held closely to the skin by a compress. Capsicum 
plaster (Emplastrum Capsici, U. S.) is useful in lumbago, rheumatism, 
and in headache when applied to the nape of the neck. The tincture 
is sometimes painted over chilblains which are unbroken. The fol- 
lowing method given by Binger, from Pheims, is very efficacious in 
this annoying affection : 

"Make a strong tincture of capsicum pods by steeping them for 
several days in a w r arm place, in twice their weight of rectified spirits 
of wine. Dissolve gum arabic in water to about the consistence of 
treacle. Add to this an equal quantity of the tincture, stirring together 
with a small brush, or a large camePs-hair pencil, until they are well 
incorporated. The mixture will be cloudy and opaque. Take sheets 
of silk or tissue-paper ; give them, with the brush, a coat of the mix- 
ture ; let them dry, and then give another. Let that dry, and if the 
surface is shining, there is enough of the peppered gum ; if not, give 
a third coat. This paper should be applied in the same way as court- 
plaster, to chilblains that are not broken and burns that are not blis- 
tered, and it will speedily relieve the itching and pain. It acts like a 
charm and effects a rapid cure. The same is true of discolored bruises. 
It likewise allays rheumatic pains in the joints." 

The dose of capsicum is 1 to 2 grains in powder, on food or in pill. 
The dose of the tincture of capsicum (Tinctura Capsici, U. S. and 
B. P.) is 10 to 30 drops, and of the oleoresin (Oleoresina Capsici, 

U. 8.), i to J grain. The dose of the fluid extract (Extractum Capsici 
Fluidum, U. S.) is 1 to 3 minims. The plaster (Emplastrum Capsici, 

U. 8.) is useful for external applications. 



CARBOLIC ACID. 

Carbolic Acid (Acidum Carbolicum, U. S. and B. P.) is also known 
as Phenol, Phenylic Alcohol, and Phenic Acid. Not only is it an 
acid, but in addition it is an alcohol of the peculiar group known as 
the phenols, which are derived from coal tar by a process of distilla- 
tion. 

It has a peculiar characteristic odor, and varies in color according 
to its method of preparation and purity. It is soluble in 20 per cent, 
of water, but is liquefied by the addition of 6 per cent, of water. 

If the crystals be exposed to the air they undergo liquefaction, and 
in consequence the purest carbolic acid is usually prescribed in drop 



116 DRUGS. 

doses rather than in grains. It is soluble in alcohol, ether, chloro- 
form, glycerin, and most oils. It unites with alkaline bases to form 
salts, carbolates, but these are very readily decomposed by the feeblest 
acids, such as carbonic acid. 

Physiological Action. — Locally applied, carbolic acid produces at 
first a burning over the skin, accompanied by a diffuse reddening of 
the surface. If the solution be very strong the part at once becomes 
temporarily painful, then bleached and numb, so that tactile sensi- 
bility is destroyed. Applied to mucous membranes it causes similar 
changes, but to a more marked degree, and may even act as a mode- 
rately severe caustic of a superficial type. Owing to the local 
coagulation of albumin produced by it it cannot penetrate very 
deeply. 

Nervous System. — Carbolic acid acts as a depressant and para- 
lyzant to the peripheral sensory nerves when locally applied. Upon 
the higher centres in the brain the acid produces a condition of de- 
pression and stupor. 

The convulsions which sometimes occur after toxic doses are spinal 
in origin, as they occur after section of the spinal cord. The motor 
nerves escape almost untouched, as do also the muscles. 

Circulation. — Upon the circulation in the higher animals the 
drug exercises a distinct depressant influence, stopping the heart 
in diastole in lethal dose and paralyzing the vasomotor centre even 
before the cardiac muscle is affected. These changes follow only lethal 
doses. Small medicinal doses have no effect of any moment upon the 
circulation. 

Respiration. — After large doses the breathing becomes more rapid 
and full. These changes, according to Salkowski and others, are due 
to stimulation of the respiratory centres and the peripheral vagi. 
Lethal doses almost invariably kill by failure of respiration due to 
depression of the centres. 

Temperature. — Carbolic acid acts as a depressant to normal 
bodily temperature even in medicinal dose, and also decreases the 
bodily heat in fever. It lowers fever by diminishing heat production 
and increasing heat dissipation. This antipyretic power is hardly 
sufficient to permit of its use in disease. (Hare.) 

Kidneys and Elimination. — When carbolic acid is given in 
overdose the kidneys may become so irritated that total urinary sup- 
pression may occur. When taken in large quantity it causes the urine 
to become brownish -black. This discoloration is due to an oxidized 
educt of carbolic which is not yet isolated. The drug is eliminated as 
a sulpho-carbolate of sodium and potassium and as glyco-uronic acid 
and hydrochinon. Part of the carbolic acid is burnt up in the body. 

It is to be distinctly understood that the dark urine of carbolic-acid 
poisoning is not due to the presence of blood or any of its educts. 

Poisoning, Prolonged and Acute. — As the changes produced in the 
tissues of the body by acute and chronic poisoning by carbolic acid 
are identical, they may be considered together. 

Carbolic acid is one of the most rapidly acting poisons known, 



CARBOLIC ACID. 117 

notwithstanding the fact that few people seem to recognize it as 
such. If a large lethal dose be swallowed by a man he may 
drop dead from its effects within a few feet of the spot where he 
stood when drinking it, or may perhaps live a few hours. In cases 
where death has occurred suddenly from the acid, the cause has 
been failure of respiration. If the patient does not die at once all 
the evidences of gastro-enteritis come on. Violent vomiting and 
purging may ensue, and burning pain in the entire abdomen is a 
prominent symptom. The skin is wet with sweat, the face pinched 
and anxious. Collapse, with a thready, imperceptible pulse and 
extreme dyspnoea may be present. The mouth and lips may not 
smell of the drug, but the mucous membrane will be seen to be 
corrugated and stained black if impure acid has been taken, or be 
whitish if the pure drug has been used. The eschar on the mucous 
membrane is a peculiar one, and is pathognomonic of the poison, 
having a white centre surrounded by a reddened and inflamed 
zone, the centre sometimes becoming dark-brown or black. The 
post-mortem will show these spots in the oesophagus and stomach, 
and even in the intestines. All the internal organs, as the brain, 
kidneys, liver, and spleen, will be found filled with dark grumous 
blood, and on opening the body the strong odor of the acid will be 
perceived. A peculiar croupous exudate is sometimes found in the 
bronchial tubes, and fatty degeneration of a more or less widespread 
type often follows carbolic-acid poisoning. 

A large number of cases are on record in which carbolic-acid poi- 
soning has been produced by its absorption from surgical dressings. 
One of the earliest signs of such an accident is a darkened, smoky 
urine and a slight nervous unrest or cerebral disturbance. Very often 
pain in the lumbar region indicates kidney strain and irritation. The 
dressings should, of course, at once be removed. 

Treatment of Poisoning. — The chemical antidote to carbolic acid 
is any soluble sulphate, such as Epsom or Glauber salts, which form 
insoluble sulpho-carbolates. As these salts follow the acid into the 
bloodvessels and tissues to unite with it, the mere fact that hours have 
elapsed since the poison has been taken does not invalidate the pro- 
priety of using these sulphates. The further treatment consists in the 
administration of warm mucilaginous drinks, hot applications to the 
extremities, the ingestion of cardiac and respiratory stimulants, such 
as digitalis and strychnine, and counter-irritation over the abdomen. 
Emetics and the stomach-pump should be used if possible, but the 
former are generally useless because of the state of the stomach. 

Therapeutics. — internally carbolic acid is little used, but, never- 
theless, has a very favorable effect in certain states. In nervous 
vomiting, or in that due to gastric irritation, the drug does good in J 
to 2 drop doses by depressing the sensory nerves in the stomach. 

In diarrhoea depending upon fermentation, from 2 to 4 drops of the 
acid do great good, particularly if combined with 10 to 20 grains of 
bismuth administered in powder or capsule. 

In gangrene and tuberculosis of the lung a spray of the acid in 



118 DRUGS. 

water in the strength of 5 to 15 drops to the ounce may do some 
good and at least stop the cough and relieve the irritation and tickling 
in the throat. 1 Creasote is, however, generally preferred in these con- 
ditions at the present time. 

Externally the acid is very largely employed as an antiseptic lotion, 
and in solutions in which to place instruments while operating. The 
solutions for this purpose should be in the proportion of 1 of acid to 
20 of water (see Antiseptics). 

Carbolic acid is rarely used directly over wounds in dressings at 
present, unless the dressing be one of carbolized oil. Other drugs have 
supplanted it. The use of the carbolized spray over wounds has been 
found to do more harm than good, and it ought never to be employed. 

In diphtheria, ulcerated sore-throat, and even in ordinary stomatitis, 
carbolic acid will be found of value when used in a spray or mouth- 
wash, and in ordinary sore-throat, in the strength of 1 part to 100 of 
water, it will be found, when applied on a swab or by a gargle, to 
relieve the pain and inflammation. In the treatment of burns car- 
bolized sweet-oil in the proportion of 1 drachm of the acid to each 6 
ounces makes one of the best dressings that can be used. By means 
of the local anaesthesia produced by the acid, minor operations, such as 
eversion of the toe-nail or opening a felon, may be performed by soak- 
ing the part for ten minutes in a solution of 30 parts to 100 and 
applying the pure acid by means of a brush to the line of the incision. 
Carbolic acid may be used as a lotion in the itching of jaundice in the 
proportion of 10 grains of the acid to 2 drachms of glycerin and 2 
drachms of water. In enlarged glands which have not yet gone on 
to suppuration, intra-glandular injections with a hypodermic needle 
are of value in a large number of cases, the solution used being no 
weaker or stronger than 2 per cent. ; 5 to 10 minims of this solution is 
sufficient for each gland. In the treatment of buboes 10 minims of 
a solution of 8 grains to the ounce may be injected into the swelling, 
the skin being first benumbed by an ether spray. This is a most 
successful treatment. The same treatment may be applied in chronic 
synovitis and repeated every three days, and boils and carbuncles may 
also be so treated with great success if the measure be used early 
enough to abort the trouble. 

In the form of an ointment carbolic acid may be used in the 
strength of 10 minims to the ounce of simple cerate, particularly in 
cases of subacute eczema where there is a great amount of w r eeping and 
itching. 

As a disinfectant carbolic acid ranks among the poorest ; 1 to 2 per 
cent, solutions, however, kill most spores and germs. 

Administration. — Carbolic acid ointment (Unguentum Acidi Car- 
bolici, U. S. and B. P.) is the only official preparation of carbolic acid 
in the U. S. P. In the B. P. the following preparations are official : 
Acidum Carbolicum Liquef actum, given in the dose of 1 to 2 minims ; 

1 The spray must be a very fine one, or it will not carry the drug far enough down 
into the lungs to do any good. 



CARBON: CHARCOAL. 119 

Glycerinum Acidi Carbolici, and Suppositoria Acidi Carbolici cum 
Sapone, each suppository containing 1 grain of carbolic acid. 



CARBON: CHARCOAL. 

Carbo Ligni, U. 8. and B. P., or Charcoal, is prepared by the ex- 
posure of soft wood to a red heat, air being prevented from coming 
in contact with the wood during the process. Charcoal when used for 
medicinal purposes should be a black, brittle, somewhat shiny, porous 
substance, devoid of taste and odor, and completely insoluble in water. 
Owing to its power of absorbing a very large amount of certain gases, 
it is of value in medicine in states where these gases abound. 

Therapeutics. — Charcoal is used externally as an application to old 
sores or sloughs to act as a deodorant and antiseptic. This is accom- 
plished by the absorption of any liquids which may be present, thereby 
depriving germs of a nidus, and by its distinct oxidizing power. It 
may be applied in the form of a dry powder or in a poultice, which is, 
however, so uncleanly that other antiseptic dressings are better. 

The poultice ( Cataplasma Carbonis, B. P.), if used, should be made 
in the following manner : Take of powdered wood-charcoal J ounce, 
bread-crumbs 2 ounces, linseed meal 1 J ounces, and add boiling water 
10 fluidounces. Macerate the bread-crumbs and meal for ten minutes 
over the fire, and then stir in the charcoal to the extent of half the 
amount just named. Spread out the poultice and sprinkle the remain- 
ing half of the charcoal over its surface, and apply to the part affected 
while hot. 

Internally, charcoal is used in powder in many conditions, and acts 
very well indeed in cases of so-called " sour stomach/ 9 from which 
eructations of gas or sour liquids take place. 

The following prescription will also be found useful in the atonic or 
subacute gastric catarrh of persons who are careless in eating and who 
have much belching : 



to 



R.. — Oleoresin. capsici 
Pancreatin. 
Pulv. zingiberis 
Pulv. carbon, ligni .. 

Ft. in pil. no. xx. S. — One or two t 



gtt. x vel 



xx. 



gr. xx. 

. gr. xl. 

. gr. xl. M. 

d. 



As ordinary charcoal is not always obtainable, it may be substituted 
by pieces of very thin toast burnt to a state of charcoal, through and 
through. A few of these pieces will, when eaten, often stop all the 
symptoms mentioned. If the attack is very severe and vomiting 
eventually ensues, the ejecta will commonly be found to be odorless 
and not sour, and the stools will also be almost odorless, though black. 
In fermentative and acid diarrhoeas in children and adults this method 
of treatment is often of value. When charcoal is used in any condi- 
tion associated with irritation of the mucous membranes of the gastro- 
intestinal tract it should always be very finely pulverized. 



120 DRUGS. 

As a filter for impure water, charcoal, in mass or in powder, is one 
of the most satisfactory substances we have. 



CARBON BISULPHIDE. 

Oarbonei Bisulphidum, U. $., is a clear, colorless, highly refractive 
liquid, having a strong characteristic odor, a sharp aromatic taste, and 
a neutral reaction. 

Poisoning. — The symptoms of poisoning by bisulphide of carbon 
consist in headache and nervous excitement resembling in many respects 
the symptoms of belladonna poisoning, particularly in the volubility of 
the patient and the evidences of hysterical tendencies. 

Prolonged exposure to the fumes of this drug causes great cachexia 
and pallor, accompanied by muscular weakness and failure of intel- 
lectual power. Sometimes convulsions of an epileptiform character 
come on. 

The treatment of poisoning by bisulphide of carbon consists in quiet- 
ing the nervous system, if convulsive disorders are present, by the use 
of bromide of potassium and chloral, and in supporting the circulatory 
system if any evidences of its failure manifest themselves. Circulatory 
depression is not, however, a common condition except in very advanced 
poisoning. 

Therapeutics. — Bisulphide of carbon has been used in medicine ex- 
ternally over enlarged lymphatic glands. The application is made by 
placing the liquid in a bottle of such a size that the mouth of the vessel 
is large enough to cover the diseased area. In the bottle should be placed 
a sponge large enough to contain a fluidrachm of the drug, and the 
skin over the gland should be well moistened with water. 

The vapor derived from the drug under these circumstances is an 
active agent in promoting a cure. Bisulphide of carbon has also been 
used in a similar manner in the treatment of neuralgia. 



CARBONATE OP POTASSIUM. 

Carbonate of Potassium (Potassii Carbonas,U. 8. andi?. P.). This 
salt is never used in medicine, except to prepare other salts, as it is 
disagreeable to the taste and is an irritant (see Potassium Citrate). 



CARBONATE OF ZINC. 

Precipitated Carbonate of Zinc (Zinci Oarbonas Precipitatus, U. S 
Zinoi Ca?'bonas, B. P.) is used as a protective, rather astringent powder 
over surfaces covered by weeping eczema and similar moist discharges. 
It may be employed to fulfil all the indications commonly treated by 
the oxide of zinc. It is very largely used, not as the precipitated car- 



CASCARA SAGRADA. 121 

bonate, but as the impure or native carbonate, under the name of cal- 
amine. 

The following prescription is useful for eczema : 

R. — Calaminse ...... gj. 

Ung. zinci oxidi 3vij, M. 

S. — Apply to the eczematous spot. 

In cases of infantile intertrigo or redness of the buttocks and geni- 
tals from maceration due to diarrhoea or urination, the following 
lotion is very useful indeed : 

R. — Pulv. calamine) _- .. 

Pulv. zinci } • • • • aa 3 ij. 

Grlycerini . . . . . . . f^iv. 

Alcoholis f ^ ij. 

Aquae q.s. ad Oj. M. 

S. — Apply after each removal of the diaper. 



CASCARA SAGRADA. 

Cascara Sagrada is the bark of the Rhamnus Purshiana, a plant 
growing in California. It is sometimes called California buckthorn, 
to distinguish it from ordinary buckthorn, or Rhamnus Fi-angula, 
which it closely resembles in many ways, and which may be used as a 
substitute for cascara sagrada in some cases. 

Therapeutics. — Cascara sagrada ought never to be used as a purge, 
but only as a laxative. It is by far the best remedy we have when 
employed simply to empty the bowel of fsecal matter in cases of con- 
stipation, since it not only performs this function without intestinal 
disturbance, but simultaneously acts as a tonic to the intestine, and so 
prevents the constipation which usually follows the use of all other 
drugs of its class. 

Though unofficial it is most commonly employed in this country in 
the form of the fluid extract (Extractum Cascarw Sagrada? Liquidum, 
B. P.) in the dose of from 10 to 20 drops at night, or morning and 
night. If 20 drops fail to act, 30 drops may be used, but if larger 
doses are required other drugs should be employed, as fluidrachm doses 
have been known to produce irritation of the bowel, with enteritis 
or intestinal catarrh. The objection to cascara sagrada is its bitter 
taste, which may be partially overcome by the additional use of the 
Syrupus Aurantii, in the proportion of 1 part of the cascara extract to 
2 parts of the syrup of orange peel. 

Some of the preparations of this drug are now made in an almost 
tasteless form, such as " Cascara Cordial/' or the non-bitter fluid ex- 
tract, made by a prominent firm in this country. The solid extract 
(Extractum Cascara? Sagrada?) is official in the B. P., and given in 
the dose of 2 to 8 grains in pill. 



122 DRUGS, 



CARDAMOM. 



Cardamom (Cardamomum, TJ. 8.) is the fruit of Elettaria Carda- 
momum, and is a bitter tonic possessing some aromatic properties. It 
is useful in cases of atony of the stomach and small intestine, particularly 
if combined with some other bitter, such as gentian, and a mineral acid. 
Cardamom is official in the B. P. as Cardamomi Semina. 

If the intestine is atonic and secretion is deficient, the following 
prescription will be found of value : 

R. — Acid, nitric, dil. f.^j. 

Tr. cardamomi comp. . . . q. s. ad fjvj. M. 
S. — Dessertspoonful after each meal. 1 

Administration. — The official preparations of cardamoms are the 
tincture of cardamoms (Tinctura Cardamomi, TJ. 8.), dose 1 to 3 
drachms; and the compound tincture (Tinctura Cardamomi Composita, 
TJ. 8. and B. P.), which is to be given in the same dose as the tincture. 
This tincture also contains cochineal, cinnamon, caraway, and glycerin. 
Cardamom is also a constituent of the official aromatic powder (Pulvis 
Aromaticus, TJ. 8.). 



CASSIA FISTULA. 

Cassia Fistula, TJ. 8., is the fruit of Cassia Fistula, or Purging 
Cassia, as it is sometimes called, and occurs in long, dark-brown pods 
containing a dark pulp in each segment. This pulp is the useful part 
of the drug, and is official in the B. P. as Cassice Pulpa. Cassia 
Fistula ought never to be used alone, as it is too apt to cause pain and 
griping, but it is officially present in the Confection of Senna (Con- 
fectio 8ennce t TJ. 8. and B. P.), and may be given in the dose of J 
drachm to 1 drachm as a laxative, or as much as J- ounce may be 
used if a purgative effect is desired. 



CASTOR OIL. 

Castor Oil ( Oleum Ricini, TJ. S. and B. P.) is a fixed oil, derived by 
expression from the beans of Ricinus Communis, a plant of the United 
States and elsewhere, but originally derived from India. It contains 
an acrid substance, ricinoleic acid. 

Physiological Action. — The manner in which castor oil purges is 
somewhat in doubt, but its activity probably depends upon the presence 
of the acid just named, and the fact that it is an oil. 

As is well known, oils, such as olive oil, for example, if given in any 

1 While the rule that an acid is incompatible with a tincture is not recognized in 
this mixture, the quantities of acid and alcohol are so disproportionate that ether 
in any amount is not developed. 



CASTOR OIL. 123 

quantity tend to move the bowels, and the ricinoleic acid, which is 
somewhat acrid, stimulates the small and large gut, and so develops 
peristaltic movement. According to some writers, this acid is not set 
free until the oil is attacked by the pancreatic juice. That this acid 
possesses purgative properties of itself seems proved by the fact that 
the oil will purge when it is rubbed in by the skin, and that nursing 
mothers on taking the oil eliminate the acid in the milk to such an 
extent that the suckling is purged. According to the studies of 
Rutherford and Vignal, the oil has no effect over biliary secretion 
other than that violent purgation indirectly increases the flow, and 
the researches of Hess have shown that the oil acts more rapidly in 
the small than in the large gut, and only produces peristalsis by 
coming in contact with the mucous membrane. 

Therapeutics. — Castor oil is the blandest and most unirritating purge 
we have with the exception of the sulphate of magnesium, which is 
depletant and much more rapid in its effects. While the Epsom salt 
will act in one-half to one hour if the stomach is empty, castor oil 
will generally act in four hours, or perhaps five. Its action is so 
regular that it can almost be used as a timepiece. 

Castor oil is used whenever irritant materials, such as bad food, 
putrid flesh, or decaying or green vegetables have been eaten, even if 
the inflammation set up after them is very active. If hard bodies, 
such as broken cherry-stones, have been swallowed, castor oil is a far 
better purge than sulphate of magnesium, as it is more gentle and 
lubricates the gut, thereby preventing scraping and irritation. Where 
mucus has accumulated in the bowel in children, and must be gotten 
rid of before other treatment is resorted to, castor oil should be used. 
Previous to 'parturition it has been largely used to relieve the bowels 
of faecal matter, and is said by old practitioners to make the labor 
easier than if any other purge is used. It is also employed in the 
constipation following acute diseases, and in that occurring in infants 
and children. 

The disadvantages of castor oil lie in its taste, the fact that it is 
oily, that it tends to produce haemorrhoids if used constantly, and 
finally that its frequent use, or even a single dose, is generally fol- 
lowed by more obstinate constipation than before, so that the dose 
must be rapidly increased in size to be effective. This is one of the 
reasons why it is useful in irritative diarrhoeas. The effect of castor 
oil is very much increased if a little bicarbonate of sodium is given 
with it. 

Administration. — Castor oil is very much more agreeable to the 
taste if pure than if poorly prepared. It is also true that too great 
purity, so far as taste is concerned, renders it less active. 

The methods directed for taking castor oil are as various as the 
tastes of individuals. Its odor may be covered by a drop or two 
of the oil of bitter almonds, but emulsions of the oil are not of any 
service, save to interfere with its efficiency. Some take the oil in the 
foam of beer or porter, others in syrup of sarsaparilla and soda- 
water, and still others in milk or cream. A good way to take it is 



124 DEUGS. 

to eat one or two strong so-called cream peppermint drops, or even the 
crystalline peppermint drops, swallow the oil from a spoon which is 
to be placed well back in the mouth, and immediately eat several other 
peppermints. This plan is improved by using the oil in milk or 
water, so that the liquid carries the oil down into the oesophagus without 
its touching the mucous membranes. It may also be taken in highly 
seasoned beef-tea. Ringer recommends the following : J ounce of 
oil, fresh syrup of acacia 3 drachms, and distilled water 5 drachms, 
flavored with a little oil of lemon or peppermint. Wood advises that 
it be mixed with glycerin, equal parts, to which is added a drop or two 
of oil of gaultheria or oil of cinnamon. By far the best way of ad- 
ministering it is in soft capsules containing from J to 1 drachm. 
Very few people are unable to swallow such a mass, and several of the 
capsules may be given at once to complete the necessary dose. The 
capsules should be lightly dipped in water in order to render them 
slipping and so easily swallowed. 

The dose for an infant is 1 to 2 teaspoonfuls, and for an adult J 
ounce to 1 ounce. 

Owing to the fact that the oil will very frequently produce griping, 
a few drops of laudanum should be added to it, or tincture of bella- 
donna may be used. If these cannot be employed, a drop of the oil 
of cinnamon is equally useful for this purpose. 



OATEOHU. 

Catechu (U. S.) is derived as an extract from Acacia Catechu. 
The catechu of the U. S. P. is true catechu ; that of the B. P. is in 
reality an extract of gambier, being derived from the leaves and shoots 
of Lncaria Gambier. Catechu depends for its medicinal use upon 
the astringent properties which it possesses. Beyond this power it 
has no particular value. 

It is of a dark-red color, has a somewhat sweetish taste, and is in- 
soluble, like most extracts, in water. 

Therapeutics. — Like all the vegetable astringents catechu is used as 
a remedy for diarrhwa, particularly that of the serous type, or that in 
which the stools are of too fluid a consistency. If large amounts of 
mucus in the passages show a catarrhal state of the bowel, the mucus 
should be displaced by a purge of castor oil or sulphate of magesium 
before the astrigent is used. 

Catechu may or may not be combined with opium in cases of diar- 
rhoea, but the following prescription will be found of service in many 
instances : 

For an adult : 

R. — Tinct. catechu composit f.^ij- 

Tinct. opii camphoratse . . . . f ^ij. 

Misturse cretse £3 ij. M. 

S. — Dessertspoonful every four hours till relieved. To be shaken before using. 



CERIUM OXALATE. 125 

In cases of sore-throat, where the secretion is excessive and the in- 
flammation subacute, catechu may be used as a gargle. 

In cases of spongy gums catechu is sometimes useful as a mouth- 
wash. If the powdered catechu is used internally the dose is 2 to 30 
grains. The dose of the Compound Tincture of Catechu (Tinciura 
Catechu Composita, U. S.) is 1 to 2 fluidrachms. Its only constituent 
besides the catechu is cinnamon. The Troches of Catechu (Trochisci 
Catechu, U. S. and B. P.) are to be employed in sore-throat aud are 
to be held in the mouth. They are not generally used. 

The official preparations of the B. P. besides the ones given are : 
Infusum Catechu, given in the dose of 1 to 1J fluidounces ; the tinc- 
ture (Tinctura Catechu), dose 1 to 2 fluidrachms, and a compound 
powder (Pulvis Catechu Compositus), composed of catechu, kino, and 
rhatany, the dose of which is 20 to 40 grains. 



CAUSTIC POTASH. 

Caustic Potash (Potassa, U. S., Potassa Caustica, B. P.) is a very 
deliquescent hard white solid, possessing great caustic power, and used 
in medicine for the purpose of burning away growths or exuberant 
ulcers. A piece of the drug should be placed on the skin by means 
of a pair of forceps, when it will at once soften down and burn the 
tissues until it can reach no further. The surrounding skin should 
be protected by wax, suet or oils, and a piece of adhesive plaster with 
a hole for the growth should first be applied to prevent any action on 
the surrounding healthy tissues. The burn produced by caustic pot- 
ash is very painful, and cauterization through its iufluence should not 
be practised if it can be avoided. When the caustic has acted suffi- 
ciently it is to be washed off with vinegar or other dilute acid. 
Vienna paste (Potassa cum Calce, U. S.) is used for the same purpose 
as is caustic potash. 

CAUSTIC SODA. 

Caustic Soda (Soda, U. S., Soda Caustica, B. P.) is milder thau caus- 
tic potash, and its action is more readily controlled. It should be used 
in the same w T ay and for the same purposes as is caustic potash, aud the 
surrounding skin ought to be protected by adhesive plaster and oil or 
ointment. 

The soda must be kept in well-stoppered bottles made of hard strong 
glass. The only official preparation of caustic soda in the U. S. P. is 
Liquor Sodce, or solution of soda. 

CERIUM OXALATE. 

Cerium oxalate (Cerii Oxalas, U. S. and B. P.) is a white granular 
powder, permanent when exposed to the air, odorless and tasteless, and 
insoluble in water and alcohol, but freely so in hydrochloric acid. 



126 DRUGS. 

Therapeutics. — It is used instead of bismuth in the treatment of the 
vomiting of pregnancy or that due to uterine disorders and displace- 
ments, and in some cases of gastric acidity. The dose is from 2 to 5 
grains given in pill form every 4 or 5 hours. 



OHENOPODIUM. 

Chenopodium ( U. S.) is the fruit of the Ohenopodium Ambrosioides 
or American wormseed. The seeds contain a volatile oil and have a 
distinct and rather disagreeable aromatic odor. These seeds rubbed up 
into a powder form with a syrup an electuary which is a most efficient 
remedy against the ascaris lumbricoides or round-worm as it occurs in 
children. The dose of the powdered seeds is from 10 to 30 grains. 
The better way of using chenopodium is in the form of the oil (Oleum 
Chenopodii, U. S.) in the dose of 10 drops to a child of five years, either 
on sugar or in an emulsion made of gum acacia. If the patient is old 
enough capsules may be used. The general dietetic measures adopted 
for the removal of worms should be insisted upon before the drug is 
given. (See article on Worms.) 



OHIMAPHILA. 

Ohimaphila ( U. S.), or Pipsissewa, is the leaves of Chhnaphila Um- 
bellata, an evergreen found in America, Europe and Asia. 

Therapeutics. — Pipsissewa is a drug employed in atonic renal con- 
ditions, particularly of the functional type, as a stimulating diuretic 
which will bring into activity the secreting structure of the kidney and 
the mucous membranes of the geni to-urinary tract. It is also a tonic 
to the stomach. For this reason it is often placed in mixtures given 
to dropsical patients if debility and anorexia are present. In the treat- 
ment of ulcers of the skin due to struma it is said to be of service, and 
it probably has some slight alterative power. The drug may be used 
in the form of a decoction, which is not official, in the dose of 1 to 3 
fluidounces, and as the fluid extract (Extractum Chimaphila? Fluidum, 
V. S.) in the dose of J to 1 drachm. 



OHIRETTA. 

Chiretta (Qhirata, U. S. and B. P.) is the plant Ophelia Chirata, 
which is a native of India. It is a bitter tonic, possessing a very 
distinct influence over the liver, and, unlike many bitter tonics, is 
devoid of tannic acid. For this reason it may be used with prepara- 
tions of iron. Chiretta may be given in all cases of indigestion and 
loss of appetite, particularly where the liver is torpid or if any tend- 
ency to constipation is present, although it is not directly laxative. 
When given in powder the dose is 20 grains ; the dose of the fluid 



CHLORAL. 127 

extract (Extr actum Chiratce Fluidum, U. S.) is 30 drops to 1 drachm, 
while that of the tincture (Tindura Chiratce, U. S. and B. P.) is 1 to 
4 drachms. The unofficial solid extract may be giveu iu pill in the 
dose of 2 to 4 grains. The dose of the infusion (Infusum Chiratce, 
B. P.) is a wineglassful. 

CHLORAL. 

Although the name Chloral is applied to the substance used in medi- 
cine, chloral proper is never so employed, hydrate of chloral (Chloral 
Hydras, B. P., Chloral, U. S.) being the real preparation. Chloral 
hydrate is a white, crystalline body, but is often sold in irregular 
broken masses, which are generally impure. 

Physiological Action. — When chloral is applied to a mucous mem- 
brane it causes distinct reddening and burning pain, and finally acute 
inflammation. It is, therefore, a local irritant. Chloral acts in the 
body as chloral, and is not broken up into formic acid and chloro- 
form, as was taught at one time. 

Nervous System. — In medicinal and toxic dose chloral produces 
sleep by quieting the intellectual centres in the brain, at the same 
time depressing the motor tract of the spinal cord and the motor 
nerves. In medicinal amounts it does not decrease sensation, but in 
toxic dose it does do so. Very often hypersesthesia results from small 
doses. Reflex action is decreased by its influence on the motor por- 
tions of the spinal cord. 

Circulation. — A dose of 10 to 20 grains, in the adult, rarely 
causes any circulatory changes, but larger amounts produce a fall of 
arterial pressure and a slow, feeble, or sometimes a rapid running 
pulse due to a direct depression of the heart muscle, for chloral is a 
cardiac paralyzant. 

After death from chloral the blood may be found dark and grumous- 
looking, with the corpuscles broken down, but these changes occur 
only after very large doses. 

Respiration. — In moderate amounts no respiratory effect is felt, 
but in toxic doses the breathing becomes slower and slower, and more 
and more shallow, until it stops in death. When death is caused by 
ehloral it is due to respiratory failure, with an almost simultaneous 
arrest of the heart. 

Temperature. — Chloral tends to lower bodily heat, and in large 
doses produces a very marked fall of temperature, which does much 
toward causing death. Brunton has found that rabbits will survive 
very large doses of the drug if external heat is supplied to them. 
The fall of temperature is, at least in part, due to the failure of the 
circulation and vascular dilatation. 

Kidneys, Tissue-waste, and Elimination. — Chloral is elimi- 
nated by the kidneys in the form of uro-chloralic acid, and, if given in 
excess, as chloral. Large amounts irritate these organs and may pro- 
duce bloody urine, owing to the nephritis which is set up as the drug 



128 DRUGS. 

passes through the renal structures. After chloral is ingested the 
urine of a patient will often give Fehling's test for sugar. 

Poisoning. — When a poisonous dose of chloral is taken by man the 
person soon falls asleep and sinks into a deep coma. The respirations 
become at first slow and labored, then shallow and feeble. The pulse, 
at first perhaps a little slowed, soon becomes rapid, thready, and shuttle- 
like, and is finally lost at the wrist. The face is white and livid, the 
forehead and the hands covered with a cold sweat, and the pupils, 
which are at first contracted, soon become widely dilated. Absolute 
muscular relaxation is present, and it is impossible to arouse the 
patient. 

Treatment of Poisoning. — The physician should apply external 
heat, and use emetics in the early stages, or if the case is seen too late 
for emetics to act because of systemic depression he should use the 
stomach-pump. This latter means of removing the drug from the 
stomach is more reliable and safer, because the production of vomiting 
may result in efforts which will strain the heart. Strychnine should 
be given in full dose, -fa to ^q- of a grain, to stimulate respiration, or 
atropine may be used for the same purpose. The heart is to be sup- 
ported by 10-drop doses of tincture of digitalis given hypodermically 
every twenty minutes until some effect is noted-; and as the digitalis 
is rather slow in its action, it may be preceded by ether and ammonia 
or brandy or whiskey. The patient must not raise the head to vomit, 
and the head should be placed on a lower level than the heels to keep 
the blood in the brain. 

In chronic poisoning the patient suffers from weakness, mental and 
physical, with sudden flushings due to vasomotor disorder, from pal- 
pitation of the heart, and finally from petechial eruptions, ulcerations 
and sloughs. 

Therapeutics. — Chloral is the purest hypnotic that we have, and 
may therefore be used where simple nervous insomnia is present, but 
not when sleeplessness is due to pain. Under such circumstances it is 
to be employed in the combination of 10 grains of chloral with ^ of a 
grain of morphine, as a much more powerful hypnotic effect is pro- 
duced by the combined action of the two drugs than by the use of 
either one of them alone. 

In tetanus and strychnine poisoning chloral is the best remedy we 
have, as it depresses the motor tract of the spinal cord. In such a 
case it should be given in 20-grain doses combined with 60 grains of 
bromide of potassium. If the convulsion prevents deglutition, or is 
brought on by swallowing, the remedy should be used by the rectum, 
and if the spasm expels it from the rectum the patient should be chlo- 
roformed long enough to allow the injection to be given and absorbed. 
The same remedies in small doses are to be used in infantile convul- 
sions and in infantile colic in the dose of J- grain to 1 grain of chloral 
to 2 grains of bromide of potassium or sodium in a teaspoonful of 
peppermint-water. In chorea, paralysis agitans, and delirium tremens 
chloral is of great service, but must be given cautiously in the latter 
condition for fear it may depress the heart, which is already diseased 



CHLORALAMIDE. 129 

by alcoholic excess. Cases are on record where chloral has caused 
sudden death from cardiac failure in the persons of alcoholics who 
were suffering from fatty heart. 

Chloral has been used for the relief of labor pains, but is rarely so 
employed, and is not a good remedy. If much rigidity of the os uteri 
exists chloral may be used with advantage to relax the spasm. The 
dose giveu should be 15 grains. In urcemic convulsions it has been 
highly extolled, but if any acute renal trouble is present it must not 
be used. In puerperal convulsions not dependent upon nephritis, 20 
to 30 grains of the drug may be given, and repeated in one or two 
hours. 

Hiccough, nocturnal epilepsy and whooping-cough are all indications 
for its use, but in asthma it rarely does good, and if pushed is danger- 
ous to the heart. 

As an antiseptic, chloral possesses a good deal of power, but is sel- 
dom used except to prevent the decomposition of urine and to assure 
the maintenance of purity in urinals used by paralytics, as in these 
cases the urine is generally heavy and ill-smelling. 

Untoward Effects. — Chloral sometimes causes nausea, purging and 
vomiting, by reason of its irritant action, and sudden cardiac failure 
in heart disease has resulted from 20 grains or less. 

Administration. — Chloral is best given in syrup of acacia, simple 
syrup, or water. It should be always well diluted. The syrup of 
chloral (Syrupus Chloral, B. P.) is given in the dose of 1 fluidrachm. 
The following prescription is useful in insomnia : 

R .— Chloralis 

Potassii bromidi 

Syr. pruni virginianse .... 

Aquse q. s. f^iij. M. 

S. — Dessertspoonful at night. 



CHLORALAMIDE. 

Chloralamide is a compound very recently introduced into medicine, 
formed by the addition of formamide to anhydrate of chloral, and is a 
colorless crystalline substance, soluble in 9 parts of water and 1 \ parts 
of alcohol. Its taste is slightly bitter, but not biting, and it keeps well 
in watery solution without decomposition. Its physiological action is 
closely allied to that of chloral, except that it is not quite so depressing 
to the circulation. Upon the nervous system it acts chiefly upon the 
brain and spinal cord, and produces sleep, a result to be expected, 
since both chloral and formamide are hypnotics. It is said not to 
irritate the stomach and kidneys, but it probably is only less irritant 
than chloral. 

Therapeutics. — Chloralamide may be employed in medicine when- 
ever chloral may be used. It is decidedly a nervous sedative, and in 
the wakefulness of nervous insomnia is very useful. Sleep generally 
ensues about thirty to forty-five minutes after it is taken. According 

9 




130 DRUGS. 

to most of the reports published so far, the drug relieves paiu as well 
as produces sleep, aud is, therefore, distinct in its actions from chloral. 
In neuralgia it is very useful, and it has been found of value in the 
pains of tabes dorsalis. The dose is 10 to 30 grains, which may be 
repeated in three or four hours, although the sleep generally lasts 
five to eight hours. The following formula may be used for its 
administration : 

R . — Chloralamide gr. xl. 

Acid, hydrochlorici dil. .... gtt. v. 

Syrupi fgij. 

Aquse dest f^ij- M. 

S. — Take in two doses in a little water. 

Very recently Charteris has obtained very extraordinary results in 
the treatment of sea-sickness by the use of chloralamide and bromide 
of potassium. He gives it in the dose of thirty grains with an equal 
amount of the bromide. It is necessary for the patient to take a 
cholagogue for two days before starting on his voyage, and as soon as 
he gets on board to take the dose named on an empty stomach and at 
once to go to bed and to sleep. If this is done Charteris claims that 
the patient will awake feeling bright and well, and remain so for the 
rest of the voyage. 



CHLORATE OP POTASSIUM. 

Chlorate of Potassium (Potassii Chloras, U. S. and B. P.) is a salt 
of potassium differing entirely in physiological action from all the 
other potassium salts, and, with the exception of the cyanide of potas- 
sium, is certainly the most poisonous. Not only is it, when locally 
applied, an irritant to mucous mem braues, but when it is absorbed into 
the blood it causes changes of a serious character in this fluid, and pro- 
duces acute nephritis if given in overdose. 

Physiological Action. — It has been thought by some that chlorate of 
potassium gives up a large amount of oxygen to the body, and for this 
reason that it would be of value in cases of slow asphyxia, such as result 
from pneumonia or phthisis. It has even been recommended to persons 
crossing high mountains where the rarity of the air produced dis- 
agreeable effects ; but nothing is more absurd than the belief that it 
gives up oxygen to the body. Chlorate of potassium does give off 
oxygen when treated with very high heat, but not at the temperature 
of the body. Nearly all of it escapes from the body unchanged. 

When overdoses of the chlorate are taken, it produces sickness of 
the stomach, headache, pain in the loins and belly, dyspnoea, cyanosis, 
heart failure, and great weakness. The blood is dark and chocolate- 
looking, this change being due to the production of methaamoglobin. 
The blood-corpuscles are crenated and broken down, and the liver, 
kidneys, spleen, and intestines are found softened and filled with 
broken-down and disorganized blood. 



CHLOKIDE OF SODIUM. 131 

Therapeutics. — Chlorate of potassium is useful in stomatitis, and 
in mercurial sore-mouth, as a mouth-wash, or, given internally, in 
the following mixture : 

R. — Potassii chlorat. gr. xlviij. 

Tr. myrrh f£ss. 

Elixir calisayae . . . . q. s. ad f^iij. M. 

S. — Teaspoonful every five hours ; or use as a mouth -wash. 

Owing to the fact that the drug is eliminated by the saliva to a 
great extent, the mucous membranes affected by stomatitis are con- 
stantly bathed by a solution of the chlorate when it is taken by the 
stomach. If any irritation of the stomach or kidneys exist, the 
medicament must be used on a swab and none of it swallowed. 

In diphtheria chlorate of potassium is very commonly employed, but 
its use is exceedingly dangerous. Death in many cases of diphtheria 
is due to the renal irritation present, or, in other words, to an acute 
nephritis, and this drug simply increases the inflammatory process. 
If the chlorate of potassium is employed in diphtheria it should be 
used in solution and applied by means of a swab. (See Diphtheria.) 

In anginose sore-throat chlorate of potassium is a useful gargle, and 
Wood recommends the use of a solution made by adding 1 ounce of 
sumach berries, j- ounce of chlorate of potassium, and 1 pint of boil- 
ing water to each other and allowing them to simmer for a few hours, 
when the mixture should be strained, cooled, and used as a gargle. 

The following is equally serviceable : 

I£. — Potassii chlorat. ^j. 

Ext. rhois glabrae fl. i% ss. 

Aquae dest q. s. ad f^iij. M. 

S. — To be added to an equal quantity of water in a glass and used as a gargle 
every two hours. 

This prescription makes an abominable-looking pharmaceutical 
preparation, but an exceedingly useful one. 

In acute rectal catarrh with mucous diarrhoea and tenesmus, a solu- 
tion of chlorate of potassium in water, 20 grains to the ounce, injected 
into the bowel, will often produce a cure after one or two injections. 
Not more than 4 ounces should be used, and it ought to be retained 
for twenty minutes. In the treatment of haemorrhoids a few drops of 
laudanum added to this solution will be found of great service. The 
troches ( Troehisd Potassii Chloratis, U. 8. and B. P.) are given in 
the dose of 1 to 6, each lozenge containing 5 grains. They are in- 
tended to affect the oral mucous membrane. 



CHLORIDE OF SODIUM. 

Chloride of Sodium (Sodii Chloridum, U. S. and B. P.), or common 
Salt, is a useful drug and food, aiding in maintaining the alkalinity 
of the blood and tissues, and in the formation of gastric juice, being 
changed by the lactic acid of the stomach into lactate of sodium. 



132 DKUGS. 

thereby setting free hydrochloric acid, which acts not only by aiding 
digestion but in the production of pepsin from the pepsinogen of the 
gastric tubules. The dose is 10 to 20 grains. 



CHLORIDE OP ZINC. 

Chloride of Zinc (Zinci Chloridum, U. S. and B. P.) is a white, 
crystalline, deliquescent powder, of caustic taste and acid reaction, 
possessing considerable disinfectant power. It has been used as an 
eye-wash in the strength of 1 to 2 grains to the ounce, but is rarely 
so employed at present. The same solution may be used as an injec- 
tion in the second stage of gonorrhoea. Under the name of Liquor 
Zinci Chloridi, U. S. and B. P., is prepared a strong solution of the 
salt for disinfectant purposes of the strength of about 50 per cent. 

Numerous experiments with the proprietary " chlorides " show them 
to be possessed of very slight disinfectant power but to be strongly 
antiseptic. 

CHLORINATED LIME. 

Chlorinated Lime {Calx Chlorata, U. S., Calx Chlorinata, B. P.), 
is the hydrate of lime containing 25 per cent, of chlorine, provided it 
is of official strength. It is an exceedingly irritant substance, because 
of the chlorine which it contains, and is never used internally. 

Much of the chlorinated lime sold is useless, containing too little 
or no free chlorine. Good chlorinated lime should be so laden with 
the gas that the face cannot be held near it without the eye being 
severely irritated. Unless the chlorine is present the substance is of 
no value, for its employment as a disinfectant depends upon the action 
of this gas, the lime being used merely as a vehicle and oxidizer, the 
gas by itself being difficult of application. 

Uses. — As a disinfectant for privies, drains, and sinks, chlorinated 
lime is one of the best, if not the best, we possess. A few pounds of 
it may be added every week to the contents of a privy vault with 
great advantage, and a solution of it may be used in all bed-pans and 
urinals. When the passages of a patient having typhoid fever are to 
be received in a bed-pan, a chlorinated lime solution should be placed 
in the receptacle beforehand, so that the faecal matter or urine will 
fall at once into a disinfecting fluid. The solution should be of the 
strength of 1 pound to 2 gallons. As it is one of the most powerful 
deodorizers, chlorinated lime should be placed liberally about decay- 
ing animals, and, in exhuming corpses, sheets wrung out in a solution 
made as above will be found of service to destroy the stench, if wrapped 
about the body. 

Water which has become foetid by stagnation may be rendered drink- 
able by adding 1 to 2 ounces of the chlorinated lime to every 65 gal- 
lons, and standing the solution aside for some hours until precipitation 
and exposure to the air have gone on for some time. 



CHLOROFORM. 138 

It should be remembered that the chlorine fumes will bleach many 
dyed goods. 

Chlorine gas, in a diluted form, has been used for the treatment of 
aphonia due to cold, in cases where the aphonia persists for some 
months. It can be obtained by allowing a few drops of hydrochloric 
acid to fall upon chloride of lime or sodium. 

The placing of chlorinated lime in saucers about sinks and closets 
is useless, as the amount of chlorine liberated is very slight as com- 
pared to the volume of air in the room. Where the chlorine is present 
in a sufficiently concentrated form to kill germs it will also kill the 
occupant of the chamber. A deodorant effect may be obtained, but a 
bad smell, if it exists, even when overcome by a greater one, is not 
really gotten rid of. The official preparations of the B. P. are Liquor 
Calais Chlorinates and Vapor Chlori. 



OHLORODYNE. 

Chlorodyne is a preparation used to a very large extent by the Eng- 
lish for the treatment of serous diarrhoeas or cramps in the stomach. 
Even in England its constitution varies considerably, but the formula 
most commonly used is as follows : 

R. — Morphinse hydrochlor gr. viij. 

Aquse dest f 5 ss. 

Heat together, and as soon as the morphine is dissolved and the liquid cooled, 
add 

Acid, hydrochlor. dil f gss. 



Ohloroformi . 

Tr. cannab. indicse . 

Acid, hydrocyanic, dil. 

Alcoholis 

01. menth. piperit. . 

Oleoresinse capsici . 



tsi- 

mj. m. 



-5 to 15 drops for an adult, in water. More than this quantity is dangerous. 



CHLOROFORM. 

Chloroform was originally discovered by Guthrie, of Sackett's Har- 
bor, New York, but first brought into medicinal use by Simpson, of 
Edinburgh. It is a clear liquid of an exceedingly hot, burning, 
sweetish taste, of a rather agreeable odor, and is very volatile in the 
presence of ordinary air. 

There are two kinds of chloroform, the purified (Chloroformum 
Purificatum, U. S.) and the commercial chloroform (Chloroformum 
Venale, U. 8., Chloroformum, B. P.) 

If exposed to the light for any length of time chloroform develops 
hydrochloric acid and certain gases which render it unfit for use. If im- 
pure because of improper methods of manufacture, an oily odor will be left 
on the hand after evaporation takes place. Under these circumstances 
the methods of purification directed by the U. S. P. should be followed in 



134 DRUGS. 

order to avoid untoward effects. Even these methods, however, do not 
give us of necessity a perfectly pure chloroform. The methods and 
researches now carried out by Pictet probably give us the safest and 
purest article. 

According to a number of recent studies chloroform vapor in the 
presence of gas flame undergoes certain changes which result in the 
development of noxious and irritating fumes consisting principally of 
hydrochloric acid. 

Physiological Action. — Locally applied to the skin, chloroform may 
produce some tingling and burning, even if evaporation be not inter- 
fered with. If it be confined under a watch-glass on the skin it will 
cause a blister and act as a counter-irritant. 

When inhaled, chloroform produces a sensation of warmth in the 
mouth and throat, a feeling of relaxation, and finally unconsciousness. 
The respirations are at first full and deep, but soon become more rapid 
and shallow. The pulse may be somewhat stronger and fuller for a 
short interval, but soon fails in strength and becomes more rapid. 
The irritation produced in the air-passages by its inhalation is very 
slight, and no primary arrest of respiration ensues, as is generally seen 
after ether is first given. The pupils are at first slightly dilated, but 
are contracted during anaesthesia. If the pupils dilate during the use of 
chloroform, after the contraction just named, danger is imminent, and 
death may suddenly occur. In some persons the first effects of chloro- 
form are violent struggles, and there is danger in trying to overcome 
these struggles by pushing the drug very rapidly. This is particularly 
apt to be the case in athletes and drunkards. Total muscular relaxa- 
tion should never be caused by the drug. 

Nervous System. — Chloroform first affects the brain, then the 
sensory part of the spinal cord, then the motor tract of the cord, then 
the sensory paths of the medulla oblongata, aud finally the motor 
portion of the medulla, thereby producing death from failure of res- 
piration unless the heart has already succumbed to the drug. On the 
sensory and motor nerves, when locally applied, it acts as an irritant 
and anaesthetic. Upon these trunks, when taken by inhalation, it has 
little effect. 

Circulation. — Chloroform may, during the first few moments of 
its inhalation, have a slight stimulant effect on the circulation, but its 
dominant effect is depressant, and it is in overdose a powerful cardiac 
poison, first dilating the ventricles and then absolutely paralyzing the 
contractility of the heart muscle. It either kills by heart or respiratory 
paralysis, or both functions cease simultaneously. McWilliams has 
found that dilatation of the heart occurs to an appreciable extent, even if 
the chloroform is gently administered and mixed with an abundance of 
air. Both sides of the heart are equally affected and the dilatation of 
the heart causes failure of the circulation before the cardiac move- 
ments entirely cease. 

Blood. — Upon the blood in the body chloroform has little or no 
effect when it is inhaled. Shaken with chloroform in a bowl outside 
the body the blood becomes scarlet in hue. 



CHLOROFOKM. 135 

Respiration. — In small amount chloroform may not be a respir- 
atory depressant, but in full dose it certainly acts as such. Death 
from chloroform may be from either respiratory or cardiac failure, 
often from both. 1 

Temperature. — Chloroform when taken by inhalation distinctly 
lowers the bodily temperature, probably by aiding in the dissipation of 
heat and by its action on the nervous mechanism of heat production. 

Elimination takes place by the lungs and by the kidneys, and 
goes on very rapidly owing to the great volatility of the drug. 

If large amounts are eliminated by the kidneys, these organs are 
apt to become irritated and inflamed. 

Antiseptic Power. — Salkowski has investigated, after Koch's 
methods, the degree to which chloroform-water acts upon microorgan- 
isms. He has also used chloroform for some years to prevent urine 
from decomposing before he had time to examine it. Chloroform 
prevents all fermentations which depend upon the growth of micro- 
organisms — e. g., alcoholic fermentation, ammoniacal fermentation of 
urine, conversion of hippuric acid by fermentation into benzoic acid 
and glycocol, lactic acid fermentation, and the putrefaction of albu- 
mins — but it has no action on those processes caused by unorganized 
ferments, as ptyalin, pepsin, etc. 

Chloroform-water may be used to prepare solutions for subcuta- 
neous injections and be given internally in diseases of the digestive 
organs depending on the presence of microorganisms — among others, 
cholera. Possibly the benefit that many patients derive from stomachic 
mixtures which contain chloroform- water is due to its destructive 
action on various microorganisms. Salkowski gave a dog 200 cubic 
centimetres (about 6J ounces) of chloroform-water with its food for 
four days without producing any ill effect, so that in the treatment 
of a disease like cholera large quantities of chloroform- water might 
be given. It may also be employed as a mouth-wash. 2 

Untoward Effects. — Sometimes during the administration of chloro- 
form the heart or respiration suddenly cease to act, and in some cases 
this change is preceded by a peculiar shade or cloud which passes over 
the face of the patient. Death often comes suddenly and without 
any warning. If untoward effects appear the anaesthetic must be at 
once withdrawn and artificial respiration resorted to. 3 Injections of 

1 For a complete study and series of experiments concerning the effect of chloroform 
see the reports of the Hyderabad Chloroform Commission, and also a paper by Wood 
and Hare, Medical News, Feb. 22, 1890; one by Mc Williams, British Medical 
Journal, Oct. 25, 1890, and one by J. C Reeve, Medical News, vol lvii , 1890. 

2 Chloroform-water is to be made by adding 1 fluidrachm of chloroform to 25 
ounces of distilled water. The mixture is then put in a well-stoppered bottle and 
shaken thoroughly until the chloroform is dissolved in the water. The dose is gener- 
ally J to 2 ounces 

3 While few text-books give any specific directions concerning the practical applica- 
tion of the methods which are to be employed in such emergencies, those that do so 
force the physician to a procedure at once dangerous and impractical ; for the direc- 
tions usually given are, to place the positive pole of the battery on the phrenic nerve 
as it crosses the anterior scalene muscle at the root of the neck, the negative pole 
being pressed against the lower margin of the ribs. A rapidly interrupted current is 



136 DRUGS. 

ether and hot brandy should be given beneath the skin, and the poles 
of a battery with a rapidly interrupted current swept over the body, 
but not held over the phrenic nerve and diaphragm. The patient 
must be held head downward, so that the blood will flow to the 
brain, and external heat should be applied. Atropine, strychnine, 
and digitalis may be used to stimulate the heart and respiration. Of 
these strychnine is the most valuable. (See directions under the 
article on Ether.) 

The measures adopted for resuscitation should not be stopped for at 
least one hour, as persons have recovered as long as this after an acci- 
dent from chloroform. 

Ostertag has found that very prolonged inhalations of chloroform 
in the lower animals produce widespread fatty degeneration. 

Therapeutics. — The first and most important use of chloroform is as 
an anaesthetic, and at this point we come to a question which has been 
for many years a matter of contention between different sections of the 
medical profession, namely, as to whether its use is very dangerous. 
In the southern and western parts of the United States chloroform is 
nearly always used, but in the eastern and northern portions it is rarely 
employed. Southerners certainly seem to take chloroform better than 
northerners or those living on the Atlantic coast. It is impossible to 
go into a general discussion of the question here ; suffice it to state 
that even the most enthusiastic supporters of the use of chloroform 
confess that it is a more dangerous drug than ether, if carelessly used, 
and while the advantages of chloroform are many, this one great dis- 
advantage overshadows them all. The advantages are — its more 
agreeable odor and the fact that it does not irritate the air-passages, 
owing to the small amount necessary to cause anaesthesia, the fact that 
it is less apt to be followed by nausea and vomiting, the rapidity of 
its action, and the small bulk which has to be carried by the surgeon. 
Its disadvantages are — the possibility of its killing the patient by sud- 
den cardiac or respiratory paralysis from which there is no relief, and 
the powerfully depressing influence which it exercises over the respira- 
tory centres. Owing to these facts these rules may be followed in 
regard to chloroform and ether : 

1. Chloroform may be used whenever a large number of persons 
are to be rapidly anaesthetized so that the surgeon may pass on to 
others and save a majority of lives, even if the drug endangers a few, 
as on the battle-field, where only a small bulk of anaesthetics can be 
carried. 

2. Its employment is indicated in cases of Bright's disease requir- 

now to be used with the purpose of causing contraction of the diaphragm by the 
direct action of the electricity upon the nerve. Even theoretically this is a possible 
source of danger, and practically the writer has proved danger to be ever present under 
such treatment. The cardiac inhibitory nerves run so closely to the phrenic fibres, 
and respond so readily to electrical stimulation, that it is hard to imagine how they can 
escape stimulation if a current be used of sufficient strength to excite the phrenic 
nerves near by. By practical experiment the writer has proved that inhibition of 
the heart may not only be possibly brought about by this method, but that it is nearly 
impossible to avoid such an effect if the phrenics are to be reached at all. 



CHLOROFORM. 137 

ing the surgeon's attention, owing to the fact that anaesthesia may be 
obtained with so little chloroform that the kidneys are not irritated, 
whereas ether, because of the large quantity necessarily used, would 
irritate these organs. Quantity for quantity, ether is, of course, the 
less irritant of the two. 

3. In cases of aneurism, or great atheroma of the bloodvessels, 
where the shock of an operation without anaesthesia would be a greater 
danger than the use of an anaesthetic, chloroform is to be employed, 
since the greater struggles caused by ether and the stimulating effect 
which it has on the circulation and blood-pressure might cause vascular 
rupture. 

4. In children or adults who already have bronchitis, or who are 
known to bear ether badly, or, in other words, have an idiosyncrasy 
to that drug, chloroform may be employed. 

5. Persons who struggle violently and who are robust and strong 
are in greater danger from the use of chloroform than the sickly and 
weak, probably because the struggles strain the heart and tend to 
dilate its walls. 

Above all things it is necessary to remember the fact that a person 
having taken chloroform twenty times before does not show he is not 
in danger on taking it the twenty-first time, and it is also to be borne 
in mind that many of the sudden deaths from chloroform have occurred 
during the first inhalation of the drug, before consciousness has been 
lost, and, therefore, when an accident was least expected. 

When chloroform is given it should be poured drop by drop upon 
a folded napkin or towel, and the cloth should then be held about 
three to six inches from the mouth and nose, so that the vapor may 
be thoroughly mixed with air in the proportion of 95 per cent, of 
air to 5 of vapor. The administration must be gradual, as " push- 
ing' 7 the anaesthetic is dangerous. The quantity of chloroform ad- 
ministered can only be imperfectly determined by measuring the 
amount thrown on the " inhaler," for during ordinary breathing one 
quantity is taken, and in exaggerated breathing much more is respired. 
Increased respiration should be a signal to withdraw the drug rather 
than to push it. 

Chloroform inhalations have been recommended in excessive chorea 
and in puerperal convulsions, and are, of course, of great service in 
the reduction of hernia, owing to the muscular relaxation produced. 
Sometimes a few whiffs will put a nervous patient to sleep. For some 
unknown reason parturient women seem able to take chloroform with 
more safety than men or women under other circumstances. 

Chloroform, when taken internally by the mouth, causes a sensation 
of warmth in the stomach and a hot, burning taste about the lips and 
buccal mucous membrane. In overdose it can and has produced death 
when taken in this manner. Although rarely used in internal medicine, 
chloroform in the form of the spirit of chloroform (Spiritus Ohloro- 
formi) is useful in cough mixtures, which are given to persons having 
an irritative cough, and in cases where, through nervousness or other 



138 DKUGS. 

cause, tickling in the throat or bronchial tubes keeps the patient con- 
tinually in a state of unrest. (See Bronchitis ) 

In severe whooping-cough a few drops of chloroform may be poured 
on the hand of the attendant and held before the child's face. While 
the child may at first dislike the odor of the drug the relief given soon 
teaches the patient its value, and he will ask for it when he feels the 
attacks coming on. If the attack is prolonged and violent this is a 
dangerous treatment, owing to the strained condition of the heart 
muscle. 

In gastric or intestinal flatulence 1 or 2 drops of pure chloroform, 
or 10 to 20 drops of the spirit of chloroform, will often give relief. 
In the treatment of serous diarrhoea when combined with astringents 
and opium the spirit of chloroform is most useful, provided that the 
irritating cause is first removed. In renal or hepatic colic a few in- 
halations, not sufficient to disturb consciousness, will not only give 
temporary but sometimes permanent relief. Hypodermic injections of 
10 to 15 drops, reaching down to a painful sciatic nerve, have been re- 
commended by Bartholow. Rubbed on the chest in the form of chloro- 
form liniment this drug will sometimes prevent asthmatic attacks, but 
it ought to be most carefully inhaled in this disease, because of the 
strained condition of the right side of the heart. In drachm doses 
chloroform has been used as a remedy for tapeworm, but ought never 
to be so employed. 

When placed in liniments of a stimulating character chloroform is 
a very useful application over muscles affected by soreness and stiff- 
ness, as in lumbago and gout, aud these liniments may also be used in 
neuralgias for their local anaesthetic effect. 

Administration. — The official preparations of chloroform are a 
liniment (Linimentum Chloroformi, U. 8. and B. P.), a spirit (Spiritus 
Chloroformi, U. 8. and B. P.), the dose of which is 20 minims to 1 
fluidrachm ; and a mixture (Mistura Chloroformi, U. S.), composed of 
chloroform, camphor, yolk of egg, and water, given in the dose of 2 
to 4 fluidrachms. The B. P. recognizes, besides those given, the fol- 
lowing preparations: Aqua Chloroformi, given in the dose of J to 2 
fluidounces ; Tinctura Chloroformi Composita, composed of rectified 
spirit, chloroform, and cardamoms, dose 20 to tiO minims ; and Tinc- 
tura Chloroformi et Morphinoe, dose 5 to 10 minims. 



CHROMIC ACID. 

Chromic Acid (Acidum Chromicum, U. 8. and B. P.) is not a true 
acid, but an anhydride, aud occurs in the form of brilliant red crystals 
which are deliquescent and possess a sour, metallic taste. It should 
never be mixed with sweet spirit of nitre, strong alcohol, or glycerin, 
as under those circumstances it may explode. 

Therapeutics. — Chromic acid is used solely as a caustic for the 
removal and destruction of growths on the skin or mucous membranes. 
The liquid, resulting from its deliquescence on exposure to the air 



CIMICIFUGA. 139 

may be employed by means of a glass rod, if a very severe action is 
needed. 

Dr. J. Wm. White has recorded a death from the application of 
this acid to a large Dumber of condylomata about the buttocks and 
vulva. Where the drug has been swallowed the patient should be 
treated for gastro-enteritis, and dilute alkalies and lime-water be used, 
as well as emetics and demulcent driuks. 

If a superficial action is desired, a solution containing 100 grains to 
the ounce of water is sufficient, and for small warts and similar growths 
this will be found strong enough. 

Liquor Acidi Chromici, B. P., is composed of 1 part of acid to 3 of 
water. 

CHRYSAROBIN, 

Chrysarobin {Chrysarobinum, U. S. and B. P.) is a mixture of the 
proximate principles derived from a powder found in the wood of the 
tree Andira Araroba, which was originally used for medicinal pur- 
poses in Brazil. In the East Indies it is called " Goa powder." 
Chrysarobin is misnamed chrysophanic acid, and is a yellow, tasteless 
powder, soluble in solutions of alkalies, in acids, and in ether. 

Therapeutics. — Chrysarobin is given internally in the dose of J- of 
a grain in psoriasis and parasitic, diseases of the skin, but more com- 
monly is employed externally in the form of the official ointment 
( Unguentum Chrysarobini, U. 8. and B. P.), which is too strong for 
direct use, and should be mixed with 4 or 5 parts of benzoated lard 
before application to the skin. As the drug stains the skin a dark- 
brown it ought not to be used on the face, although the discoloration 
may be removed by a weak solution of chlorinated lime. In psoriasis 
the following may be employed : 

R. — Chrysarobini gj. 

XSlis} a**, ad ft. sol. 

Collodii fgij. M. 

S. — Apply to the part affected, with a brush, after a bath. 



CIMICIFUGA. 

Clmicifuga (U.S.). This drug is derived from Cimifuga Race- 
mosa, otherwise known as black cohosh or black snake-root. It con- 
tains a resin and a volatile oil, upon which its medicinal powers are 
supposed to depend. The fluid extract and tincture should always be 
freshly prepared from the fresh crude drug. It is official in the B. 
P. as Cimicifugce Rhizoma. 

Physiological Action. — In large doses cimicifuga paralyzes the sen- 
sory side of the spinal cord, and in consequence lowers reflex activity. 
It has no effect on the nerves and muscles. On the circulation the 
drug acts by depressing the heart and vasomotor system. Death is 



140 DRUGS. 

due to respiratory arrest. In small dose it is a cardiac stimulant. In 
overdose it Dearly always produces frontal headache. 

Therapeutics. — Cimicifuga is, after arsenic, the best remedy we have 
for chorea, particularly if the patient is otherwise in good health, but 
it should be used with careful attention to the bowels and often be 
accompanied by iron. In chronic bronchitis it is asserted to be of 
value, and in rheumatism of a subacute or chronic type cimicifuga 
sometimes gives relief. 

Cimicifuga has been highly praised in the treatment of neuralgia, 
particularly of the ovarian type, and in amenorrhea, subinvolution, 
and tenderness of the womb. To women who state that they caunot 
step off a step without paining or hurting the uterus or ovaries, cimici- 
fuga often gives relief. Some writers assert that it is an efficient and 
active heart tonic in cases of fatty and irritable heart when digitalis 
fails. There can be no doubt that it is a powerful uterine stimulant, 
and it ought not to be used during pregnancy for fear of abortion. 
By reason of this power it may be employed instead of ergot during 
labor, and is better in some cases, because it produces normal, not 
tonic contractions. In the treatment of headache, arising from over- 
straining of the eyes in study, cimicifuga is said to do good. 

The drug is official in the form of the fluid extract (Extr actum 
Cimicifagce Fluidum, TJ. S. and B. P.), the dose of which is 10 to 30 
drops, or even 1 drachm, and the tincture (Tinctura Cimicifugm, TJ. S. 
and B. P.), the dose of which is 1 to 2 drachms. 



CINCHONA. 

Cinchona, TJ. S., is a name applied to the bark of all the trees be- 
longing to the genus Cinchona, provided they contain as much as 2 
per cent, of the alkaloid quinine. The same barks are included under 
the name of Cinchona Cortex, in the B. P. There are thirty-one 
species of this genus, but only a comparatively small number can be 
included in the list of 2 per cent, of obtainable alkaloid. These are 
the Cinchona Calisaya, or Cinchona Flava, TJ. S., which contains the 
most quinine, the Cinchona Condominea, Cinchona Micrantha, Cin- 
chona Succiruba, or Cinchona Rubra, TJ. S., Cinchona Rubra Cortex, 
B. P., and Cinchona Pitayensis. The first is called yellow bark, the 
second pale bark, the fourth red bark. The alkaloids of the quinine 
series derived from these barks are quinine or quinina, quinidine or 
quinidiua, and quinicine, which is an artificial alkaloid. Of the cin- 
chonine series we have cinchonine (Cinchonina, TJ. $.), cinchonidine 
(Cinchonidino3 Sulphas, TJ. S. and B. P.), and cinchonicine, which last 
is also an artificial alkaloid. Besides these alkaloids we have present 
kinic and kinovic acids and other inert and useless substances. 

As quinina is the most important of the group, and as its physio- 
logical action is virtually identical with the rest, whatever is said 
hereafter in this article refers to quinine unless it is otherwise 
stated. 



CINCHONA. 141 

Physiological Action. — When quinine is taken in overdose it causes 
ringing in the ears, dizziness, disorders of taste and smell, disturbance 
of vision in some cases, and fulness in the head. Deafness often 
comes on, and is generally, with the roaring in the ears, the most 
pressing symntom. Headache is not uncommou. 

Nervous System. — Upon the cerebrum quinine acts as a stimu- 
lant, aud, finally, as a congestant, if given in excessive dose. If 
poisonous doses are used intense cerebral congestion ensues, and, 
finally, unconsciousness comes on. On the spinal cord the drug first 
causes a decrease in reflex action by stimulating Setschenow's reflex 
inhibitory centre, and, finally, by depressing, the spinal cord and 
nerves. The latter changes occur only after poisonous doses. 

Circulation. — If quinine, even in small amount, be injected into 
the jugular vein of a dog, so that it goes in concentrated form to the 
heart, cardiac paralysis will result. If this does not occur the drug 
decreases pulse-force, rate, and arterial pressure. In minute doses the 
drug acts as a general stimulant to the entire body and so supports 
the circulation. 

Blood. — The blood after poisonous doses is more coagulable than 
normal, but in medicinal amounts no such effect is produced. The 
movement of the white blood- cells through the walls of the capillaries 
in inflamed areas is checked by large doses of quinine, and medicinal 
amounts increase the number of the red blood-corpuscles very mate- 
rially. It is said that quinine prevents the oxygen- bearing powers 
of the corpuscles, but this probably does not occur from medicinal 
doses. 

Eespiration. — Upon respiration quinine acts as a slight stimu- 
lant in small doses, but as a marked depressant in poisonous amounts, 
death being most commonly due to failure of respiration if it be taken 
by the stomach in lethal dose. 

Temperature. — Quinine lowers bodily temperature in health very 
little if at all, and in fevered states its influence is governed by the 
cause of the fever. Thus in malarial fevers quinine is a very power- 
ful antipyretic. 

In fever before crisis quinine is of little service, but in that after 
crisis it causes a rapid fall. 

As an antiseptic quinine has considerable power. 

Quinine is absorbed from the stomach, not from the intestine, and 
it is precipitated by the alkaline juices of the bowel. 

Kidneys, Elimination, and Tissue -waste. — Quinine escapes 
from the body chiefly through the kidneys, although much of it is 
destroyed by oxidation in the liver and tissues. The process of ex- 
cretion of quinine is by no means rapid so far as the entire quantity 
to be eliminated is concerned. While it may in rare instances be 
found in the urine in fifteen minutes from the time it is given, it does 
not disappear from this secretion for about twenty-four hours. In 
the urine it is found as quinine and as dihydroxyl quinine. 

Upon tissue- waste quinine acts as a depressant and decreases the 
elimination of nitrogenous materials. 



142 DRUGS. 

Poisoning and Untoward Effects. — Severe poisoning so seldom occurs 
as the result of the ingestion of overdoses of quinine that untoward effects 
is the best term with which to qualify the disagreeable symptoms which 
sometimes come on in persons having an idiosyncrasy to the drug, and 
who are in reality poisoned by small doses. In these cases sudden, 
complete, but temporary blinduess is often met with. De Schweinitz 
has shown that in dogs quinine produces in toxic doses permanent 
optic atrophy and thrombosis of the central vein of the retina. He 
believes that the drug produces local changes in the vessels of the eye 
(endo-vasculitis.) In other instances complete deafness asserts itself, 
due to congestion of the middle ear, while skin eruptions, generally of 
the nature of erythema, are not rarely seen. After lethal doses 
haemorrhage into the middle ear may be found, and severe epistaxis 
may ensue after so small a dose as 4 grains. The buzzing in the ears 
can generally be put aside by 10 grains of bromide of sodium with a 
little ergot. Karamitsas has proved that quinine may produce hsema- 
globinuria in persons suffering from malarial poisoning, and may even 
develop bilious remittent fever. 

Therapeutics. — This drug is employed in medicine to fulfil four 
great offices, although its influence in other directions is hardly less 
powerful. These are as an anti-periodic or anti-malarial, as an anti- 
pyretic, as a tonic possessing peculiar virtues, and as a stimulant to the 
parturient uterus. 

For many years physicians were forced to employ this drug empiri- 
cally, not knowing the cause of the disease process called malaria. 
We now know that the theory of Binz, offered as long ago as 1867, is 
correct, and that malaria is due to the presence of a germ, the plasmo- 
dium malaria?, which was first accurately studied by Laveran, and 
named by Marchiafava and Celli. These and other investigators have 
found that quinine acts as an active poison to these germs, even in so 
weak a solution as 1 to 20,000. 

For the reasons given in the preceding paragraph, quinine is the 
best remedy we have for malarial fever, as a prophylactic and cure, 
and it should be given in doses which are indicated by the state of the 
patient. (See Malarial Fever.) It should always be preceded by a 
purge having an hepatic action, if this is possible. This fact is par- 
ticularly important in bilious or remittent fever. The drug should be 
given in hourly doses or in one or two large doses in such a way that 
its influence is fully felt, not at the time of the expected paroxysm, but 
about an hour or thirty minutes before that time. If the paroxysm is 
near at hand, the drug should be given in solution, bitter though it be, 
in acidulated water. 

Asa prophylactic against malaria the dose of quinine should be 2 
to 4 grains, or more, three times a day. 

In malarial cachexia or hemorrhagic malarial fever, quinine gener- 
ally does more harm than good. Under such circumstances the 
danger in using quinine consists in irritating the engorged kidneys 
after the chill has passed by. The quinine is not a haemostatic, and 



CINCHONA. 143 

only does good in malarial hematuria by preventing the paroxysm 
which will produce the bloody urine. To give quinine after this 
symptom appears is to "lock the door after the horse is stolen." In 
hematuria occurring from chronic malarial poisoning without a chill 
quinine is of no value. 1 

In pernicious malarial fever quinine should be given by the mouth, 
by the rectum and hypodermically, as much as 60 to 70 grains being 
used at a dose. In brow ague or malarial neuralgia quinine often acts 
most usefully, and this is also true in some cases of ordinary nerve- 
pain not dependent upon a specific disease. 

For the reduction of the pyrexia of typhus or typhoid fever, quinine 
will be found inferior to the new antipyretics, even when given in very 
large dose, and ought to be used very rarely. It will seldom cause a 
fall of temperature before crisis or lysis, but will aid in the fall very 
actively after these changes have occurred. 

As a tonic quinine is not only a simple bitter, but also seems to 
have a direct effect in increasing the number of the red blood-corpus- 
cles. The tonic dose should be 1 to 2 grains three times a day. 

In parturient women the drug undoubtedly aids in the expulsion 
of the child by stimulating the uterine contractions, either by a direct 
influence over the uterus, or by supporting the system. Its use is 
particularly indicated in cases where the pains have ceased because 
of exhaustion from prolonged labor. The dose should be 10 to 20 
grains dissolved in water iu order that immediate absorption may 
occur. Quinine will not of itself cause abortion. 

In the lobar 'pneumonia of children quinine should be used in sup- 
positories in the dose of 2 grains three times a day. 

In cases where prolonged meutal or physical strain is to be undergone, 
quinine in the dose of 2 to 4 grains will often prevent exhaustion and 
support the system. 

Used in solution in the form of a spray by the atomizer, quinine is 
of undoubted service in whooping-cough, and will often prevent the 
spread of the disease to other children if they be subjected to its use. 
The solution should contain from 1 to 2 grains to the ounce and be 
employed every few hours. It is well to remember that quinine is 
not tasted by the tip of the tongue, but is tasted by the back portion. 
The tip of the atomizer should therefore be carried well back of the 
root of this organ and a 1 per cent, solution of cocaine painted over 
the dorsum of the tongue in cases where the disagreeable taste of the 
quinine is objected to very strongly. The same solution of quinine 
used, by means of an atomizer, in colds in the head and in fwtid sore- 
throat is often of service. 

A very much more agreeable method of pursuing this treatment in 
whooping-cough is to give the patient the so-called quinine chocolates, 
which are made of 1 grain of tanuate of quinine and chocolate. They 
do not taste of quinine at all, if well made. Several prominent drug 

1 See collective investigation of this subject by the author in Therapeutic Gazette, 
for July, 1892. 



144 DRUGS. 

firms manufacture these chocolates. One or two may be allowed to 
dissolve in the child's mouth three times a day. 

Administration. — Quinine ought never to be given in solution if 
it can be avoided, because of its disagreeable taste. In adults and 
children it should be used preferably in small capsules and in pills, 
which may be gelatin- or sugar-coated. Care should be taken that 
the gelatin is thin aud the sugar not hardened by age, for if the pill 
escapes into the intestine the quinine is precipitated and not absorbed. 
If the case is that of a child too young to take a pill, the drug may be 
given in the following manner without tasting very disagreeably : 

R. — Quininse sulph. ...... gr xyj. 

Ext. glycyrrhiz. . . •..-.•. ■ oj- 
Syrupi aurantii cort. vel syrupi zingiberis vel 

yerba santi . . . . . . f^ij. M. 

S. — A teaspoonful t. d. for a child of three years. 

In some cases quinine chocolates may be used, but unless they are 
well made the after-taste of quinine is well marked. When they are 
used the tannate of quinine should always be placed in them. In 
other cases quinine may be used in the suppository in the dose of 2 to 
3 grains, care being taken that irritation of the rectum does not ensue. 

For hypodermic use the bisulphate of quinine (Quinince Bisulphas, 
U. S. and B. P.) should be used most commonly, as it is soluble in 
about 8 parts of water. To its solution should be added a little tartaric 
or sulphuric acid to prevent precipitation of the drug in the alkaline 
juices of the connective tissues before it can be absorbed. The tartaric 
acid should be present in the proportion of about 1 grain to each 5 
grains of the quinine. If sulphuric acid is employed 10 grains of 
the sulphate of quinine should be added to a drachm of water aud the 
acid added, drop by drop, until the salt is dissolved. The hydro- 
bromate of quinine (Quinince Hydrobromas, TJ. S.), the solubility of 
which is about 1 to 16 of water, may also be used hypodermically, as 
may also the bimuriate of quinine and urea ( Quinince Bimuriatica 
Carbamas), which, however, is scarcely more than half as strong in 
quinine as the other salts. The hydrochlorate of quinine is also a use- 
ful salt for hypodermic use, and is the strongest in alkaloid. It may 
be employed in the following manner : 

R . — Quininge hydrochlorat gr. vij. 

Aq^tst.} ■ • ' ' • " '*- M - 

S. — Warm solution before using it and do not add acid. 

R. — Quininse hydrochlorat gr. xv. 

Alcoholis HI xv. 

Aquae dest. ...... f £jss. M. 

S. — Add a few drops of hydrochloric acid to complete the solution before using. 

The best place to give the hypodermic injection is in the buttock 
between the trochanter and the tuberosity of the ischium. Injections 
into the calf of the leg are very painful. 



CINCHONA. 145 

In Italy Baccelli has resorted to the intravenous injection of quinine 
in pressing cases. He employs the following solution for this purpose : 

R • — Quininse hydrochlorat gr. xv. 

Sodii chloridi ...... gr. xij. 

AquBe dest. f^ijs's. M. 

S — This should be injected, after distilled water is added to it, into a vein of 
the leg rather than into a vein of the arm, to avoid too great an effect on the heart, 
and the solution should be boiled and filtered before using, and used while warm. 

As quinine in concentrated form is a powerful heart depressant, the 
injection should be given very slowly indeed when intravenous methods 
are employed. 

Valerianate of quinine (Quinines Valerianas, U. 8.) is given in 1 
to 2 grain doses, and the hydrochlorate (Quinince Hydrochloras, U. 8. 
and B. P.) in the dose of 1 to 10 grains. The alkaloids of cinchona 
other than quinine which are commonly used in medicine are cinchoni- 
dine, cinchonine, quinidine, and chinoidium. Cullen, Sinkler, and 
De Bran have all found the sulphate of cinchonidine very useful in 
malaria, and it is less bitter and more soluble than is quinine. Sinkler 
states that it does not produce the severe head symptoms caused by 
quinine. 

The dose of quinidine sulphate ( Quinidince Sulphas, U. 8.) is about 
twice that of quinine, as is also that of cinchonine sulphate (Cincho- 
nince Sulphas, U. 8. and B. P.) and cinchonidine sulphate (Cinchoni- 
dina Sulphas, U. S. and B. P.). The tannate of quinine is a salt not 
so bitter as the other salts and is weaker in relative alkaloidal strength. 
One grain of the tannate equals about one-fourth of a grain of pure 
alkaloid. The bisulphate equals about two-thirds and the sulphate 
three-quarters of a grain of the pure alkaloid. 

Chinoidinum is a resinous mass obtained in the preparation of the 
alkaloids of cinchona, and contains amorphous alkaloids. It possesses 
distinct anti-periodic power and may be used freely where cost is a 
matter of importance. Its dose is 3 or 4 times that of quinine. 

The liquid preparations of cinchona are the infusion (Infusum Cin- 
chonce, U. S.), dose a wineglassful ; the tincture ( Tinctura Cinchonas, 
U. S. and B. P.), one to two teaspoonfuls ; and the compound tinc- 
ture (Tinctura Cinchonas Composita, U. S. and B. P.), a teaspoonful 
to a tablespoon ful. Under the name of elixir roborans or Whytt's 
tincture,, a similar mixture is employed for precisely the same purposes. 
Huxham's tincture is a most efficient and elegant bitter tonic in debility 
and convalescence from low fevers. It is too weak to be used in 
malarial poisoning. The other liquid preparation is the fluid extract 
{Extractum Cinchonce Iluidum, U. S. and B. P.), dose 5 to 15 drops. 
A solid extract (Extractum Cinchonas, U. S.) is also official in the dose 
of 5 to 10 grains. The B. P. preparations not official in the U. 8. P. 
are as follows : Decoctum Cinchonce, dose 1 to 2 fluidounces ; Infusum 
Cinchonce Acidum, dose 1 to 2 fluidounces ; Tinctura, Quinince Am- 
moniata, dose J- to 2 fluidrachms ; Vinum Quinince, dose J to 1 fluid- 
ounce. 

10 



146 DRUGS. 

Contra-indications. — Quinine is contra-indicated in gastritis, cyst- 
itis, meningitis, epilepsy, cerebritis, middle-ear disease, and in those 
cases which have an idiosyncrasy to its action. 



CINNAMON. 

Cinnamon [Cinnamomum, U. 8., Cinnamomum Cortex, B. P.) is the 
inner bark of the Cinnamomum Zeylanicum, a native of Ceylon, or of 
the species indigenous to China. It contains a volatile oil and tannic 
acid. In overdose the oil acts as a soporific, and kills by failure of 
respiration. 

Therapeutics. — Cinnamon is used, as are all the drugs of its class, 
for flavoring, as a carminative, and as an intestinal stimulant in serous 
diarrhoeas. It has the peculiar power of acting as a haemostatic in 
uterine haemorrhage where the flow is oozing and not active, thereby 
differing from the other volatile oils, with the exception of that of 
erigeron. 

Administration. — The dose of the oil {Oleum Cinnamomi, U. S. and 
B. P.) is 1 to 5 drops ; of the water ( Aqua Cinnamomi, U. 8. and 
B. P.) a wineglassful or less ; of the spirit (Spiritus Cinnamomi, U. 8. 
and B. P.) 5 to 30 drops ; of the tincture ( Tinctura Cinnamomi, U. 8. 
and B. P.) \ to 1 drachm. Under the name of Puhis Aromaticus, 
U. 8. {Pulvis Cinnamomi Compositus, B. P.), a carminative powder, 
consisting of cinnamon 35 parts, nutmegs 15 parts, cardamoms 15 
parts, and ginger 35 parts, is official. It is useful in the treatment 
of the flatulence of adults and children. The latter should take about 
10 grains at a dose, an adult 30 grains. 



CITRATE OF POTASSIUM. 

Citrate of Potassium (Potassii Citras, U. 8. and B. P.) is a white, 
granular, deliquescent salt, almost neutral in reaction and very soluble 
in water. It is by far the most agreeable of all the salts of potassium 
to the taste. In the early stages of bronchitis it is of the greatest 
value when combined with ipecac (see Bronchitis), and it is also use- 
ful as an alkaline diuretic. In bronchitis the dose should be 20 grains 
every four hours, and in urinary incontinence due to acid and concen- 
trated urine the dose should be equally large. 

Under the name of neutral mixture (31istura Potassii Citratis r 
U. 8.), made by adding to 1 pint of lemon-juice enough bicarbonate 
of potassium to neutralize it, we have a useful febrifuge drink in fevers, 
particularly those of childhood. The dose is J to 1 ounce every few 
hours. 

Liquor Potassii Citratis, U. 8., is made in the same manner as is the 
neutral mixture, except that citric acid is substituted for the lemon- 
juice (citric acid 720 grains, potassium bicarbonate 960 grains, and 
water 24 ounces). 



CLOVES. 147 

Neutral mixture is the better preparation of the two, but more ex- 
peusive. A very refreshing and agreeable way of prescribing this 
drug is in the form of " effervescing draught/' made by mixing two 
solutions which are prepared as follows : 1. Lemon-juice and water, 
equal parts, enough to make 4 ounces. 2. Bicarbonate of potassium 
1 drachm, and water 3 ounces. These solutions are to be mixed in 
the quantities desired and taken while effervescing. If lemon-juice is 
not at hand, a solution of citric acid of the strength of 2 drachms to 
4 ounces of water should be employed in its stead. 



CITRIC ACID. 

Citric Acid (Acidum Oitricum, U. S. and B. P.) is chemically 
identical with the acid of the lemon, but has not identical influences 
over the body with lemon-juice. 

Not only does the lemon owe its acidity to this acid, but most of 
the other edible fruits, such as strawberries and raspberries, depend 
upon its presence for their acidity. 

Therapeutics. — Citric acid is used in scurvy or scorbutus as a pro- 
phylactic and cure. For some unknown reason pure lemon-juice 
seems to benefit these cases more than citric acid itself, and it is, there- 
fore, to be preferred to the latter whenever it can be had. In order 
to keep lemon-juice from decomposition on long voyages, it should be 
boiled, and poured while hot into bottles until it nearly reaches to the 
cork ; the remaining space is then filled with a thin layer of sweet oil 
and the bottle corked and stood upright. Under these circumstances 
the juice may be kept indefinitely. 

In some cases lemon-juice or lemonade will cause indigestion and a 
sensation of weight in the stomach ; particularly is this the case with 
the sick. This is due to the presence of soluble irritant albuminoids, 
which should be precipitated by boiling the lemonade, decanting the 
solution on cooling, and leaving the precipitate to be thrown away. 
If the supernatant liquid is cooled and properly sweetened it is almost 
as agreeable as the fresh juice and devoid of irritant power. 

In rheumatism, either acute or chronic, lemon-juice may be em- 
ployed in the dose of 1 to 2 ounces four times a day, well diluted, or 
2 drachms of citric acid may be given. The acid is also of value in 
hepatic inactivity and catarrhal jaundice. (See Citrate of Potassium.) 

The preparations containing citric acid are Syrupus Acidi Oitrici, 
U. S., Succus Limonis, B. P., and Syrupus Limonis, B. P. 



CLOVES. 

Cloves (Caryophyllus, TJ. S., Caryophyllum, B. P.) are the unex- 
panded flowers of the Eugenia Caryophyllata, a plant of the East and 
West Indies. They possess an aromatic odor and the pungent taste 
of a typical spice. They contain a volatile oil (Oleum Caryophylli, 



148 DRUGS. 

U. 8. and B. P.), which is yellow when fresh , but very dark colored 
when old. 

Therapeutics. — Cloves, or their oil, are used in medicine for the 
purpose of acting as a carminative. They are also employed as a 
stimulant and tonic to the stomach to prevent griping during an attack 
of diarrhoea or that caused by purgatives, to act as a flavoring agent, 
as a counter-irritant, and, finally, as a parasiticide and local anaesthetic. 

Like all volatile oils, this oil is an efficient local application for 
pediculis pubis and similar parasites, and it may be used in toothache 
because of its anaesthetic powers if placed on a pledget of cotton in the 
cavity of a tooth. In the treatment of myalgia or muscular rheu- 
matism oil of cloves is often placed in the liniment for its counter- 
irritant effect. In overdose it acts as a soporific and kills by failure 
of respiration and the production of marked gastro-enteritis. Minute 
doses of J to 1 drop of the oil in a little water will sometimes control 
excessive vomiting. In addition to the oil the B. P. has an official 
infusion, Infusum Caryophylli, the dose of which is 1 to 2 fluidounces. 



COCA AND COCAINE. 

Cocaine is the alkaloid derived from Erythroxylon Coca, a shrub of 
Peru and Bolivia. A second alkaloid, known as Ecgouine, has en- 
tirely different powers. It is to be distinctly understood that Ery- 
throxylon Coca is not the same as chocolate, or Theobroma Cacao. 
Erythroxylon Coca is official in the B. P. as Coca and in the U. 8. P. 
as Erythroxylon. 

Physiological Action. — Coca and its alkaloid cocaine, when taken 
internally, produce a sense of exhilaration and pleasure. Often the 
amount of muscular and mental power is temporarily increased under 
their influence. When locally applied to a mucous membrane cocaine 
causes a blanching followed by marked congestion. 

Nervous System. — The dominant action of cocaine, when locally 
applied, is to paralyze the peripheral sensory nerves. When taken 
internally it stimulates the brain to an extraordinary degree, but ex- 
ercises no effect upon the sensory nerves. Sometimes its internal use 
produces a decrease of sensation which Mosso believes to be due to an 
influence on the spinal cord. This effect is, however, very feeble. If the 
dose be a poisonous one, convulsions of cerebral origin ensue, and are 
clonic in type. 

The sensory nerves are paralyzed by enormous doses, both when the 
drug is directly applied or when it is taken internally. 

Upon the muscles, when taken internally, Mosso has proved the 
drug to be a direct stimulant, and it is particularly active after starva- 
tion or fatigue. 

Circulation. — Cocaine acts as a stimulant to the heart and cir- 
culation in moderate amounts, but its effects are not marked except in 
poisonous dose. 



COCA AND COCAINE. 149 

Kespiration. — The drug acts as a powerful respiratory stimulant, 
producing in large dose a great increase in the rapidity of the respira- 
tory movements. 

Temperature. — Cocaine raises bodily temperature to a very ex- 
traordinary degree if given in overdose, this rise being due to an 
increase of heat-production. (Eeichert.) In moderate amounts it has 
no effect. 

Kidneys, Elimination, and Tissue- waste. — The drug is elimi- 
nated by the kidneys, but is chiefly destroyed by oxidation in the 
body. The quantity of urine passed is increased under its influence, 
and the nitrogenous elements eliminated in this fluid are a little 
diminished. 

Eye. — Owing to its powerful action as a local anaesthetic, cocaine 
has been used largely in diseases of the eye. The anaesthesia comes 
on in from one to five minutes after the use of the drug, according to 
the strength of the solution used, and is accompanied by very marked 
dilatation of the pupil. It is important to remember that this dilata- 
tion, unlike that produced by mydriatics such as atropine, does not 
paralyze accommodation. The dilatation of the pupil is due to a 
peripheral stimulation of the sympathetic nerve. The drug does not 
cause a forcible mydriasis, and is never used for the prevention of adhe- 
sions in iritis. 

Therapeutics. — Cocaine hydrochlorate (Cocaines Hydrochloras, B.P.) 
is used as an anaesthetic in the eye in the dose of from 3 to 5 or more 
drops of from a 1 to a 4 per cent, solution. The strength of 2 and 3 
per cent, is perhaps most commonly employed. 

The conditions indicating its use are all operations upon the eye of 
a painful character, be they what they may, and it is also to be used 
for the relief of pain when an acute inflammation or foreign body is 
causing suffering. 

The following formula will be found useful in these states : 

R . — Cocain. hydrochlor gr. viij. 

Acid, boric gr. vij. 

Aquae dest f Ijj. M. 

S. — Use with a dropper in the eye every hour until relieved. 

Cases are recorded in which cocaine has caused permanent corneal 
opacities. 

Where enucleation of the eyeball is to be practised the drug should 
be replaced by general anaesthetics, but cocaine may be used if it is 
injected deeply around the eyeball. 

Owing to the density of the mucous membranes of the vagina and 
rectum, cocaine has little effect upon them unless used in 10 per cent, 
solution and profusely applied. In the mouth cocaine may be used 
in cases of stomatitis where a spot is to be cauterized, in pharyngitis 
and in soreness and tenderness of the gums. While it gives much 
temporary relief in pharyngitis the subsequent effects are often ex- 
ceedingly disagreeable, the congestion looking more angry and being 
more painful than before, and the experience of the writer indicates 



150 DRUGS. 

that it will only act in a curative manner if applied before the capil- 
laries become relaxed or paralyzed by the severity of the inflamma- 
tory process. In coryza and hay fever sl powder consisting of cocaine, 
morphine, and bismuth in the proportion of one part each of the two 
alkaloids and five parts of the bismuth will often be of service if 
snuffed up into the nostrils. If cocaine be applied to a large nerve- 
trunk, amputation of the tributary limb may be performed without 
pain, but so large an amount of the drug must be used that there is 
great danger of poisoning the patient. 

Cocaine is generally used at present in the place of ether in cases 
requiring amputation of the fingers, or in cases of minor surgery where 
the drug can be confined to the part injured. A tight cord should be 
bound around the base of the finger and a 4 to 8 per cent, solution 
injected into the part, a ligature about the base of the digit being 
used to prevent hemorrhage and the systemic absorption of the drug. 
After the operation is concluded slight haemorrhage should be allowed 
to occur to sweep out the drug, and thereby avoid systemic medi- 
cation. 

Internally, cocaine or the fluid extract of coca may be used as a 
supportive and stimulant in low fevers, and in cases where great 
physical and mental strain is to be borne. Thorington has found 
cocaine of very great value as a stimulant and anti-emetic in yellow 
fever. 

Cocaine is undoubtedly of service in the opium habit, but if largely 
used soon changes the patient from a case of morphiomania to a "coca 
fiend." In the vomiting of pregnancy and other forms of excessive 
emesis it is of great service by depressing the gastric sensory nerves and 
thereby decreasing the irritability of the stomach. The dose of the 
fluid extract (Extr actum Erythroxyli Fluidum, U. S. and B. P.) is 
from J to 2 drachms. That of cocaine from \ to \ grain. The other 
B. P. preparation is Lamella? Cocainw, each disc containing yj-g- grain 
of cocaine hydrochlorate. 

A new preparation of cocaine which is said to possess very distinct 
advantages over those commonly employed is the phenate of cocaine. 
As is well known, carbolic acid exercises, even when used alone, very 
marked anesthetic powers and simultaneously coagulates the albumiu 
in the tissues with which it comes in contact. One of the dangers in 
the employment of the hydrochlorate of cocaine is its absorption and 
the production of poisoning. The phenate of cocaine is insoluble in 
water and is therefore very slowly absorbed, and in addition coagulates 
the albumin, thereby imprisoning itself. By this means not only are 
the dangers named avoided, but the period of anaesthesia is greatly 
prolonged. As the phenate of cocaine is soluble in alcohol there is 
generally much pain when it is used hypodermically. The manu- 
facturers state that this may be largely avoided by the use of the 
following : 

J&. — Cocain. phenat gr. 1J. 

Alcoholis f.^jss. 

Aquse dest f ^jss. M. 

S. — 20 minims to be given at each injection. 



COD-LIVER OIL. 151 

Whether phenate of cocaine will prove of much value remains to 
be seen. 

Untoward Effects. — Sometimes loss of speech, blindness, nausea and 
vomiting, syncope and unconsciousness, have followed the internal use 
or local application of cocaiue. Epileptiform convulsions have also 
been noted, while the circulation and respiration have been disordered 
in every posible manner. In many of these cases the urine passed after 
the poisoning is very limpid and contains albumen. Curiously enough 
a large number of cases of severe poisoning have followed the injection 
of cocaine into the urethra previous to some operation for the relief 
of chronic gonorrhoea or stricture. 



CODEINE. 

Oodeina, U. 8. and B. P., is an alkaloid prepared from opiurn, and 
is often contaminated by morphine. Its physiological action is very 
closely allied to that of its sister alkaloid — morphine — but it is very 
much less powerful. 

Physiological Action. — Codeine resembles morphine very decidedly 
in its physiological action, the chief difference being that it possesses 
less narcotizing power, but in large amount more- readily produces 
tetanus and final paralysis of the peripheral motor nerves in the lower 
animals. (Dott and Stockman.) 

Therapeutics. — Codeine has been highly recommended in France 
as a nervous quietant, and in this country in nervous cough, or in 
cases where the cough is excessive in bronchitis and phthisis. In 
diabetes mellitus some clinicians have found it of the greatest value, 
while others have been disappointed in its use. It should, however, 
always be tried in this disease, in the hope that it may exercise a 
favorable effect. When given for cough it should be used in the 
dose of from J to 2 grains, generally placed in the syrup of wild- 
cherry bark. Much so-called codeine consists largely of morphine. 



COD-LIVER OIL. 

Oleum Morrhuce, TJ. S. and B. P., is a fixed oil obtained from the 
fresh livers of the Gadus Morrhuce, or cod fish. There are several 
species of cod from which the oil is obtained other than the one 
named, but this is the chief source of supply. The oil is pale or 
dark, according to its degree of freedom from foreign materials. Al- 
though the paler oils are generally prescribed, there can be little 
doubt that the darker ones are more medicinally active. The most 
prominent inorganic constituents of the oil are iodine, bromine, sul- 
phuric and phosphoric acids. It also contains more or less of the 
biliary salts. 

Physiological Action. — Cod-liver oil depends on a number of sub- 
stances for its peculiar effect. The iodine certainly exerts certain 



152 DRUGS. 

alterative powers aud the oil seems peculiarly adapted to digestion and 
absorption, for cod-liver oil passes through animal membraues very 
readily, probably owing to the biliary salts contained in it. 

It aids in the maintenance of bodily temperature by its oxidation 
and causes a deposit of fat in the tissues. The oil also seems to influ- 
ence the blood directly, for clinical observation shows that anaemic 
persons become healthy-looking under its use, and Cutler aud Brad- 
ford have found that this is a physiological fact by the use of Malas- 
sez's blood-cell counting apparatus, the red corpuscles being always 
increased. It has been proved by experiment that this oil is more 
readily oxidized than any other. 

The belief among physicians that the effects of cod-liver oil are 
dependent upon some peculiar combination of substances has shown 
itself in the attempts of physiological chemists to isolate the combina- 
tion. One of the best results reached is the so-called " Morrhuol " of 
Chapoteau, who seems to have isolated a crystalline substance con- 
taining phosphorus, iodine, and bromine. Three to five grains of this 
preparation are said to represent one drachm of the pure oil, and it is 
certainly of value as a medicament in most of the states in which we 
use the oil itself. In " colds" which u hang on " and are not readily 
gotten rid of, morrhuol is best given in capsule or pill. This sub- 
stauce is put on the market in gelatin -coated pills or capsules. 

Therapeutics. — Cod-liver oil is useful in persons who have no tuber- 
cular lesion in the lungs or other tissues, but have mucous membraues 
which are readily susceptible to disease. This state has been called 
the pre-tubercular stage of phthisis. Cod-liver oil possesses no curative 
power in cases of well-developed phthisis, and its administration in 
many cases only serves to nauseate and distress the patient or to pro- 
duce an oily diarrhoea through failure of digestion. It may be used 
in the early part of the disease as a food but not as a cure. In chronic 
rheumatism the drug is often of great service, particularly if the disease 
is largely muscular. Strumous skin lesions depending for their exist- 
ence not only upon scrofulosis but also upon anaemia often yield to its 
use. In enlargement of the lymphatic glands, where they are not under- 
going acute active suppuration, cod-liver oil does good. This is a 
statement requiring explanation. By acute active suppuration is meant 
the early formation of pus or the molecular death of the parts — not 
the slow formation characterized by no active change but represented 
by cold abscess or old sores. If the discharge is chronic the oil does 
good. In strumous ophthalmia cod-liver oil is of great service. In 
advanced syphilis cod-liver oil is most useful, and in the early stages 
of rickets it ought always to be employed. In marasmus, when used 
by inunction or taken internally, if the stomach will stand it, it is one 
of the best drugs we have. If a few grains of bile-salts, consisting of 
glycocholate and taurocholate of sodium, be added to each drachm of 
oil it will be very readily absorbed from the skin. 1 

1 These salts may be bought, or made as follows : To about 300 c.c. of ox-gall is 
added nearly thrice that quantity of ordinary alcohol, and the flask shaken thoroughly. 
All the mucus is now precipitated and the supernatant fluid is filtered. To the fil- 



COD-LIVER OIL. 153 

In sciatica and lumbago and in neuralgia cod-liver oil is of service. 
In emphysema of the lungs it is said to be of great value, and certain 
writers commend its use in gout, although, others have asserted that it 
is of no value. Sometimes old persons, whose digestion is not dis- 
ordered and who have no organic brain disease, complain of giddiness. 
The best treatment for this condition, in many instances, is cod-liver 
oil with doses of quinine ; or, if these fail, wine of ergot and one of 
the bromides may be used. 

Administration. — Owing to its disagreeable taste and smell most 
patients rebel against taking cod-liver oil ; but this can, with a little 
persistence, be readily overcome, so that finally the patient may not 
only not object to its use but actually like it. This is particularly 
true of young children. The secret of reaching this much-to-be-desired 
state lies in the use at first of doses which may be dropped into a tea- 
spoon and the spoon then gently submerged in a glass of milk. The 
oil floats off into the milk in a globule in the centre of the tumbler, 
and if the milk be rapidly gulped down without the oil touching the 
sides of the glass it will not be tasted. The first gulps must be large 
enough to include the oil. The oil may be taken on a full stomach, 
but as a general rule it is best digested if taken about two or three 
hours after meals, when the gastric contents are about to be passed into 
the small bowel, where the oil is digested, and if it be followed in five 
or ten minutes by a little pancreatin its disgestibility will be much in- 
creased. Other modes of ingestion consist in the placing of the oil in 
whiskey or brandy, in the manner which has been described with milk, 
and this method possesses the advantage that the alcohol aids very dis- 
tinctly in the absorption of the oil. Sometimes a pinch of salt placed 
in the mouth before and after the oil is taken aids in covering its taste 
and in its digestion. (See Indigestion.) Oil of eucalyptus in the pro- 
portion of 1 to 100 of the cod-liver oil will cover the latter's taste, but 
many dislike the eucalyptus more than the cod-liver oil. The addition 
of an equal quantity of glycerin, with J to 1 drop of the oil of bitter 
almonds to each dose, is often of service. Syrup of bitter orange-peel 
is one of the best covers to its taste. Tomato ketchup has also been 
used with good results. Chewing a piece of smoked herring before 
and after taking the oil is of value to disguise the taste in some cases. 
The oil is readily taken in soft capsules, holding from J to 1 drachm. 
Very few people are unable to swallow them if they are first made 
slippery by dipping them in water. 

Cod-liver oil is most readily digested when given in single nightly 
doses after supper, or after a light meal just before going to bed. After 
a few days it may be given after dinner, and in the course of a week 
after breakfast. If the patient is once nauseated by overdoses it is 

trate is added a large excess of sulphuric ether, and after a time a plaster-like mass 
forms at the bottom of the vessel, which slowly becomes crystalline. These crystals 
are now placed on a filter paper and washed with a mixture made up of ether and 
alcohol, equal parts. The filter paper is dried and the substances then seen are the 
taurocholate and glycocholate of sodium. Having carefully removed these salts from 
the paper they are ready for use. 



154 DRUGS. 

almost impossible to make the stomach retain the oil. If it cannot be 
digested a drachm of ether aids in its absorption, or a drink of whiskey 
or brandy may be used instead. 

A large number of preparations of cod-liver oil are on the market 
in emulsion, pancreatized and purified till they are nearly tasteless. 
Many of the permanent or perfect emulsions contain more Iceland 
moss or acacia than oil. One of the emulsions widely advertised in 
the street cars of Philadelphia as "tasteless," has been shown to 
contain no oil at all. The pancreatized emulsions are the best if 
the oil is really present in sufficient quantity to do good, as the very 
fact of its being artificially digested adds to its value and the possi- 
bility of putting more oil into the emulsion. Oil devoid of smell is 
probably devoid of medicinal value, as all the peculiar properties have 
been " purified " out of it. 



COFFEE. 

(See Caffeine.) 

OOLOHIOUM. 

Colchicum is the conn (Golchici Cormus, B. P.; Colchici Radix, 
U. S.) and seed (Colchici Semen, U.S.; Colchici Semina, B. P.) 
of the Colchicum Autumnale, a plant of Europe, containing an alka- 
loid, colchicine, which may be still further changed into colchiceine. 
While the drug is official in the form of the seeds and root, the former 
are rarely employed. 

Physiological Action. — Colchicum is a very powerful drug, and 
when locally applied is an irritant to the gastro-intestinal mucous 
membrane. 

According to the studies of one of the writer's students — Dr. Ferrer 
Y. Leon — the drug has little or no effect when given in moderate 
dose on the nervous system, circulation, respiration or temperature, 
only producing changes in these parts when given in poisonous doses. 
Jacobi asserts that death is produced by respiratory failure, the heart 
continuing to beat for many minutes after respiration ceases. The 
violent gastro-enteritis which is present in colchicum poisoning cer- 
tainly has much to do with the fatal result in man. 

Therapeutics. — The employment of colchicum in medicine centres 
around its use in gout and similar states, such as chronic rheumatism 
or rheumatoid arthritis. Indeed it is almost a specific in acute gout, 
provided that it be pushed until it causes slight griping or laxity of 
the bowels. Care must be exercised under these circumstances that 
" retrocedent gout " does not occur, owing to the manifestations of the 
disease leaving the toe and going to the internal viscera. In some 
cases iodide of potassium should be used in conjunction with the col- 
chicum. This is particulary the case in subacute or chronic cases. 



COLLODION. 155 

The use of eolchicum in such doses as to cause severe purgation or 
emesis is dangerous, and ought not to be resorted to. Colchicine can 
be used successfully against gout in the dose of yJ-Q to ■£$ of a grain. 

Poisoning. — The symptoms of poisoning by eolchicum are nausea, 
griping, agony in the belly, purging followed by the passing of thick 
mucus with great and increasing tenesmus, profuse salivation, collapse, 
and death from exhaustion and gastro-enteritis. Bloody purging is 
almost never seen. The poisoning is one of the most painful, slow, 
and hopeless poisonings known, and a man taking as much as an 
ounce of the wine of the root or the seed is almost inevitably doomed 
to a terrible death. Tannic acid may be used as a partial chemical 
antidote, and the stomach washed out with emetics and the stomach- 
pump. Opium is to be used to relieve the pain and irritation, and 
oils are to be given to soothe the inflamed mucous membrane. If 
collapse comes on, external heat and stimulants are to be used, and 
atropine may prove of service under these circumstances. 

Administration. — Colchicum ought never to be used in substance, 
but should be employed in the form of wine of the root ( Vinum Col- 
chici Radicis, TJ. S.) in the dose of 10 to 20 drops, although if a 
marked effect is required 30 drops may be used. The extract {Ex- 
tractum Colchici Radicis, .TJ. S.) is given in the dose of 2 to 3 grains, 
and the fluid extract (Extractum Colchici Radicis Fluidum, TJ. S.) in 
the dose of 2 to 4 minims. 

Of the seeds the tincture (Tinctura Colchici Seminis, TJ. S. and 
R. P.) is given in 30 to 90 minim doses ; the wine ( Vinum Colchici 
Seminis, TJ. S.) in the same amounts, and the fluid extract {Ex- 
tractum Colchici Seminis Fluidum, TJ. S.) in the dose of 2 to 5 drops. 
The R. P. preparations besides those given are Vinum Colchici, dose 
10 to 30 minims ; Extractum Colchici, dose J to 2 grains ; and Ex- 
tractum Colchici Aceticum, dose J to 2 grains. 



COLLODION. 

Collodium, TJ. S. and R. P., is a solution of gun-cotton in alcohol 
and ether, and is a clear, syrup-like fluid, smelling strongly of ether. 

Therapeutics. — Collodion is used as an air-tight dressing for small 
wounds and abrasions, and for rendering small dressings waterproof. 
A difficulty in its use consists in the contraction which takes place as 
it dries, drawing and puckering the part sufficiently to cause not only 
discomfort but acute pain. It should be applied with a camel's-hair 
brush over the part affected. 

In boils when they are beginning in a small pustule or papule with 
an inflamed zone, collodion painted over the spot will generally abort 
the disease. If the boil has burst, this treatment is useless, but if it 
has not the pus should not be liberated, but allowed to become in- 
spissated. By this treatment and by the frequent application of a coat 
or two, the trouble eventually disappears. Of course, this rule only 
applies to certain cases, and if pain is caused by the retention of the 



15(3 DRUGS. 

pus it must be evacuated with autiseptic precautions. In smallpox 
the flexible collodion may be used to prevent pitting. 

In gouty inflammations of the joints an application of collodion 
mixed with iodine, equal parts, will often remove the pain, although 
at first the suffering may be increased by this treatment. 

Flexible Collodion. 

Flexible Collodion (Collodium Flexile, U. 8. and B. P.) is made by 
adding turpentine 5 parts and castor oil 3 parts to ordinary collodion. 
It does not contract or become hard, and is generally to be preferred 
to ordinary collodion in the dressing of wounds. 

Styptic Collodion. 

Styptic Collodion (Collodium Stypticum, U. 8.) contains tannic acid, 
and is employed to control small haemorrhages. It is seldom used, and 
its employment is a dirty way of controlling bleeding. 

Cantharidal Collodion. 

Cantharidal Collodion (Collodium cum Cantharide, U. 8.) has been 
referred to under the head ofCantharides. Collodium Vesicans, B. P., 
is identical with this preparation, and is used for the same purpose. 



COLOCYNTH. 

Colocynthis, U. 8., is the fruit of the Citrullus Colocynthis, a plant 
at present largely grown in all parts of the world. It contains an 
alkaloid, colocynthine, and a resin. Neither of these are ever used in 
medicine. Colocynth causes large watery evacuations, and may, in 
very large dose, produce fatal gastroenteritis. It is official in the 
B. P. as Colocynthidis Pulpa. 

Therapeutics. — Colocynth is never used alone, but always in com- 
bination with other drugs of its class as a hydragogue cathartic. 

In cases of chronic dropsy or for serous effusions it is generally given 
in the form of the compound extract of colocynth (Extractum Colo- 
cynthidis Compositum, U. 8. and B. P.), which contains 16 parts of 
colocynth, 50 parts of purified aloes, 14 parts of the resin of scam- 
mony, 6 parts of cardamom, and 4 parts of soap. In the dose of 5 to 
20 grains this acts as a powerful watery purge. The extract (Extrac- 
tum Colocynthidis, U. S.) is given with other drugs in the dose of 2 to 
5 grains as a purge. The following is a useful form in which to ad- 
minister it : 

R . — Extract, colocynth. comp. . . . . gr. xxx. 

Extract, belladonnse . . . . . gr. ij. 

Extract, nucis vomicae . .... gr. ij. M. 
Ft. in pil. no. x. S. — One in the morning. 



CONIUM. 157 

Colocynth is one of the principal ingredients in compound cathartic 
pills (Pilulce Catharticce Compositce, U. 8.). Each pill contains : com- 
pound extract of colocynth, 1 J grains ; abstract of jalap and calomel, 
of each 1 grain ; gamboge, \ grain. 

The preparations of the B. P. not official in the Z7. 8. P. are : 
Pilula Colocynthidis Composita, composed of colocynth pulp, aloes, 
scammony, sulphate of potassium, and oil of cloves, dose 5 to 10 
grains, and Pilula Colocynihidis et Hyoscyami, dose 5 to 10 grains. 



CONIUM. 

Conium ( U. 8.) is the leaves and fruit of the Conium Maculatum. 
The plant grows in Europe and the United States, and contains a resin 
known as coniine. This drug is official in the B. P. as hemlock 
leaves (Conii Folia) and hemlock fruit (Conii Fructus). 

Physiological Action. — When conium is taken in very full dose it 
causes weakness and a sense of relaxation, giddiness, staggering, and 
disordered vision, with failure of the circulation. 

Nervous System. — Conium causes paralysis of the motor nerves, 
and, if the dose be extraordinarily large, depression of the sensory 
nerves. Upon the spinal cord it exerts a feeble, depressing influence, 
but has no positive effect, while the fact that consciousness continues 
almost up to death shows that the intellectual portion of the cerebrum 
escapes its influence. 

Circulation. — The action of the drug upon the circulation is 
depressant. It causes at first a fall of arterial pressure, then a rise, 
due to the asphyxia caused by nervo-muscular failure of the respira- 
tory apparatus. Finally a constant fall of pressure takes place. 

Respiration is depressed because of the influence of the drug on 
the nerve-trunks supplying the respiratory muscles. 

Therapeutics. — Conium holds an unimportant place in the drug-list 
of to-day. 

It has little value except in spasms due to irritation of a nerve- 
trunk, when it may be of service. In spasms of cortical or spinal 
origin other drugs should be used, as it is evident that conium has 
really no effect in quieting the central nervous protoplasm, but only 
prevents the impulses which are sent out from manifesting themselves 
in movements of the muscles. The powdered leaves or other prepara- 
tions may be smeared over poultices to relieve the pain of idcers and 
cancers, and it certainly does good in such instances. 

Administration. — The dose of the abstract (Abstraction Conii, U. 8.) 
is from \ to 3 grains, that of the alcoholic extract (Extractum Conii 
Alcoholicum, U. 8.) is from J to 1 grain, and of fluid extract (Ex- 
tractum Conii Fluidum, U. 8.) 2 to 6 drops. The dose of the tincture 
(Tinctura Conii, U. 8. and B. P.) is 10 to 30 drops. Coniin is a 
liquid alkaloid which should never be used. The dose Avould be about 
-gL of a grain. The dose of the hydrobromide of coniin is said by 
Helbing to be J to J a grain. The preparations in the B. P. made 



158 DRUGS. 

from the leaves are : Cataplasma Conii, for external use ; Extractum 
Oonii, dose 2 to 6 grains or more ; Succus Conii, dose 30 minims to 2 
fluidrachms or more ; Vapor Conii, for inhalations ; and Pilula Conii 
Composita, composed of extract of hemlock and ipecac, dose 5 to 10 
grains. Vapor Conii consists of the juice of hemlock (succus conii) J 
ounce, liquor potassa 1 drachm, and distilled water 1 ounce. Twenty- 
drops of this mixture are placed in hot water in an inhaler and so 
employed for the relief of irritative coughs or spasmodic asthma. 

It is to be remembered that the variability of the drug, so far as 
power is concerned, is very great — so great as to make it unreliable. 
For this reason a small dose should be given at first and the amount 
gradually increased. 

Poisoning. — A prominent symptom of poisoning by conium is 
dropping of the eyelids (ptosis), due to paralysis of the oculo-motor 
nerves, and staggering and inability to walk. Its treatment consists 
in the use of strychnine as a respiratory and nervous stimulant, the 
employment of external heat, and the use of cardiac stimulants if the 
circulation fails. The stomach is to be emptied by emetics or the 
stomach-pump before the antidotes are used. 

COPAIBA. 

The Copaiba of the U. S. P. and B. P. is really the balsam or 
the oleoresin of Copaifera Langsdorffii, and is a clear, transparent 
liquid of oily consistency, of a pale yellow color and a peculiar odor. 
From it is distilled an oil (Oleum Copaibw, U. S. and B. P.) which is 
of little value. 

As copaiba is an oleoresin, the term " oleoresin of copaiba " is often 
used to distinguish it from the oil. 

Therapeutics. — Copaiba is used for the purpose of stimulating the 

mucous membranes of the genito-urinary tract, particularly when they 

'are depressed after a period of inflammation, as in the later stages of 

gonorrhaza. In cases suffering from chronic urethritis with anaemia 

and debility the following pill is useful : 

R . — Oleoresinse copaibse gj. 

Oleoresinse cubebse ..... gtt. iv. 

Ferri et ammonii citratis . . . . gr. xx. M. 
S. — Ft. in capsule no. x. One t. d. after meals. 

Copaiba is employed in subacute and chronic bronchitis as an expec- 
torant. In the treatment of subacute pyelitis, cystitis, and dysentery it is 
of value. In dropsy due to slow renal changes it will often be of service. 

Administration. — Copaiba itself is given in the dose of 5 to 20 
minims in capsule or in emulsion. The oil of copaiba ( Oleum Copaiba?, 
U. S. and B. P.) is given in capsule or emulsion, preferably in the 
former, in the dose of 10 to 20 minims two to four times a day. Some- 
times it is dropped on sugar and so administered. Massa Copaibce, 
U. S., is made by rubbing up copaiba with magnesium, but this is- 
a useless and clumsy way of using it in the pill form. 



COPPER. 159 

The drug is eliminated in the urine, and gives the test for albumin 
with nitric acid. 

In some cases it causes urticaria, which soon ceases on the with- 
drawal of the drug. 

COPPER. 

Cuprum is never used in the form of the metal itself, but chiefly as 
the sulphate, which appears in commerce as a blue, clear, somewhat 
efflorescent salt. It is soluble in four parts of cold water, two of boil- 
ing water, but is not soluble in alcohol. 

Physiological Action. — Copper sulphate, when locally applied to a 
mucous membrane, acts as a powerful astringent, or, on the surface 
of an ulcer, as a mild and superficial caustic. Upon the nervous 
system in cats it acts at a depressant poison when given hypoder- 
mically, finally causing death from respiratory failure. When given 
in overdose by the stomach it causes death by violent gastro-enteritis 
and exhaustion. The symptoms do not generally come on for an 
hour, and consist in burning pain in the stomach, a copperish or me- 
tallic taste in the mouth, followed by vomiting of bluish liquids and 
glairy mucus. With the vomiting purging comes on, the passages at 
first containing the contents of the intestine, and finally mucus and 
blood. Convulsions of an epileptiform character are present, and con- 
stant and profuse salivation is not infrequent. After death fatty 
degeneration of the liver and kidneys has been noticed, and it is not 
at all uncommon for jaundice to appear after the first twenty-four 
hours, if the patient survives so long. This jaundice is dependent 
upon changes in the blood. The treatment of the poisoning consists 
in the primary use of the chemical antidote, which is the yellow prus- 
siate of potassium, and the administration of emollient or demulcent 
substances, such as sweet oil and white of eggs, followed instantly by 
emetics, or the stomach-pump. If emesis and purgation are already 
active, emetics are of course contra-indicated and counter-irritation 
is to be employed over the stomach and intestines in the shape of a 
mustard plaster of moderate strength, with opium to allay irritation 
and relieve pain. 

Chronic copper-poisoning is almost never seen, and although the 
metal is largely used for coloring canned green vegetables, it seems to 
be harmless in such small amounts. 

Therapeutics. — Sulphate of copper (Otcpri Sulphas, U. S. and B. P.), 
in the dose of 5 to 7 grains, may be used as a rapidly acting emetic 
which only acts upon the stomach, not the vomiting centre. As it 
is irritant the emetic dose ought not to be repeated, but if emesis 
does not occur, the sulphate of zinc or mustard should be used in its 
stead. Indeed, it may be said of sulphate of copper that it should 
never be given as an emetic, except in phosphorus poisoning, when it 
acts as the chemical antidote. Even here its use must be most cau- 
tious, for Thornton has proved that an antidotal dose of copper sul- 
phate given to a dog poisoned with phosphorus may produce death 



160 DRUGS. 

before the phosphorus can do so. In pill form it is sometimes given in 
diarrhoeas depending upon ulceration of the bowels. The dose should 
be \ to 1 grain combined with opium. 

In some states of the body, particularly in shin diseases of the dry 
type and in persons with tubercular tendencies, copper seems to act 
like arsenic and may be used in minute doses of ^ of a grain or less 
three times a day where arsenic is not well borne. In small doses it 
is said to be a direct stimulant to the tissues and to increase the firm- 
ness of the flesh and strength of the normal man. Very recently strong 
claims for copper as a remedy for anosmia have been put forward, par- 
ticularly if it is employed as the arsenite of copper, when the action of 
the arsenic and copper together produce a good effect. 

Injected into the rectum in the strength of 5 to 20 grains to the 
ounce the drug will be found of service in those cases of diarrhoea 
which arise in the lower bowel and are dependent upon ulceration. 

Locally applied, sulphate of copper is useful, in the solid form or 
in powder, in the treatment of indolent ulcers. In chronic conjunc- 
tivitis or in cases of tinea tarsi — that is, tinea on the margin of the 
eyelids — a crystal of the sulphate may be drawn over the diseased 
spot ; or a weak solution of 1 to 3 grains to the ounce of water may 
be dropped into the eye in subacute conjunctivitis. 

In relaxed sore-throat, as a gargle, in the strength of 4 grains to the 
ounce, it is often of service. Nitrate of copper ( Oupri Nitras, B. P.) 
and acetate of copper (Oupri Acetas, U. S.) serve the same purpose as 
the sulphate. 

OREASOTE. 

Creasote (Creasotum, U. S. and B. P.), as employed in medicine, 
should always be derived from the destructive distillation of beech- 
wood and be designated " beechwood creasote/' Much of that sold is 
derived from coal-tar and is far less useful. Chemically, creasote is 
almost identical with carbolic acid. Clinically it is very different. 
It is a powerful antiseptic. Beechwood creasote should be of a red- 
dish amber hue and about as thick as olive oil. Its physiological 
action is almost identical with that of carbolic acid, and in poisoning 
by creasote the same antidotes as are employed in carbolic-acid poison- 
ing, namely, soluble sulphates, should be used. 1 Creasote contains 
60 per cent, of guaiacol and 40 of cresol, not creosol. Guaiacol is 
sometimes used in place of creasote in the dose of 1 to 2 minims. 
(See Guaiacol.) 

Therapeutics. — During the past few years creasote has been largely 
prescribed in phthisis and chronic bronchitis, and some of the results 
reached by its use have undoubtedly been of value. It has also been 
inhaled from sponges with great relief, and even has been injected 
into the lungs by the trachea or through the chest- wall. (See article 
on Tuberculosis.) In the treatment of chronic bronchitis, creasote 

1 See University Medical Magazine, 1889. 



CREOLIN. 161 

may be placed in boiling water and inhaled in the steam. Under 
these circumstances it at least relieves the foetor of the breath, and this 
method often gives more rapid relief than any other measure in ordi- 
nary subacute inflammation of the bronchi. The beginning dose when 
the drug is given internally is 2 to 5 drops. Applied on a pledget of 
cotton to the cavity of a tooth creasote often relieves toothache. 

When given in phthisis the following prescription may be used, 
or the drug may be placed upon a Yeo's inhaler and inhaled in that 
way: 

R. — Creasoti (beechwood) . . . . f ^iij. 

Tinct. gentian, comp. . . . . . f ,^j. 

Spt. vini rectificati ..... f Jviij. 

Yini Xerici . . . . q. s. ad Oij. M. 

S. — A tablespoonful in a wineglassful of water three times a day. 

Creasote is useless so far as producing a cure is concerned if tuber- 
culosis is more than incipient, and ought not to be employed if it dis- 
orders the stomach. The drug is contra-indicated in phthisis if fever 
or haemoptysis are present, and those patients who have little fever 
and a chronic phthisis are the most favorable subjects for its employ- 
ment, as are those in which the bronchial tubes seem to be much affected. 
Inhalations of the drug often give relief in the advanced stages of 
phthisis and decrease the cough, allay the laryngeal dryness, and aid 
expectoration. When creasote is given hypodermically in phthisis it 
should be given in the following formula : 

R. — Creasoti f ^ij. 

Olei amygdal. dulcis f ^ij. M. 

S. — Ten minims to be injected deeply into tissues below the scapula. 

Unless the patient is fastidious the creasote may be dropped into 
half a glass of milk and taken in this three times a day. Often as 
much as a drachm can be given by gradually producing tolerance 
through ascending doses, and it is worthy of note that in most in- 
stances large doses are required if satisfactory results are expected. 

The preparations of creasote are Aqua Creasoti, B. P., given in the 
dose of 1 to 3 fluidrachms; Mistura Creasoti, B. P., dose 1 to 2 fluid- 
ounces ; Unguentum Creasoti, B. P., for local application, and Vapor 
Creasoti, B. P., used by inhalation. 



CREOLIN. 

Creolin is a liquid cresol, a coal-tar product possessing marked anti- 
septic but comparatively slight poisonous properties. In appearance 
it is a dark-brown fluid and is derived from soft coal. It is of the 
consistency of syrup. When added to water it forms a white cloud and 
mixes thoroughly, forming an emulsion up to 12 per cent, of the drug. 

Therapeutics. — Creolin is used as an antiseptic in the lying-in 
state, as a wash for the hands and for vaginal irrigation. It cannot 
be used as a solution in which to place instruments, as it makes so 
opaque a mixture with water as to prevent their being -seen at the 

11 



162 DKUGS. 

bottom of the dish. When used as a vaginal douche it should be 
employed in the strength of 2 per cent. One property of value is 
that it forms a slippery coatiug over the mater ual parts during partu- 
rition. In the treatment of cystitis in the female, Parvin highly recom- 
mends it as a vesical wash in the strength of a 1 per cent, solution, 
or, after the bladder becomes accustomed to its use, in a 2 per cent, 
solution. According to Kretzschmar and others, a solution of 1 to 
500, used with a syringe, is useful in otorrhea, 1 to 100 in nasal 
ulcers, and 1 to 1000 as a nasal douche in rhinitis, when there is much 
discharge with the formation of crusts. Creolin has also been used as 
an injection in the proportion of 5 parts in 1000 of water for dys- 
entery and entero-colitis with success. 

In the eye, Alt has used a 1 to 2 per cent, solution in the treatment 
of blepharitis, keratitis, and phlyctenular ophthalmia. 



OROTON CHLORAL. 

Croton Chloral, or Butyl Chloral Hydras, B. P., has a physiological 
action closely allied to chloral itself, but possesses more aualgesic 
power and is very much less depressant to the heart and circulation. 
The dose for the production of sleep is the same as chloral, 5 to 20 
grains in syrup. 

Therapeutics. — Croton chloral is infinitely preferable to chloral in 
sleeplessness due to pain. 

In facial neuralgia and migraine it is exceedingly efficacious, par- 
ticularly if the fifth nerve be involved. In headaches due to eye- 
strain, and in those associated with sick stomach, but not due to gastric 
indigestion or nervous debility, croton chloral is of service. Curiously 
enough it is valueless in toothache, but does good in the neuralgia due 
to decayed teeth. 

Administration. — Croton chloral should be used in pill form in the 
dose of 3 to 5 grains every two hours till the pain is relieved or sleep 
comes on, or it may be given in solution or syrup of acacia and 
water, or water and glycerin. It has been used in as large a dose as 
60 grains, but 20 to 30 grains ought to be the maximum dose as a 
general rule. 

CROTON OIL. 

Croton oil {Oleum Tiglii, U. 8., Oleum Crotonis, B. P.) is an ex- 
ceedingly irritant oil derived from Croton Tiglium, a small tree of" 
India. The oil is pale yellow and of a complex character. Applied 
to the skin for any length of time it is an intense irritant, producing 
blisters or pustules. One drop placed on the tongue with 5 drops of 
sweet oil acts as a violent watery purge, and, owing to the smallness 
of its dose, it is frequently employed to revulse the unconscious, as in 
cerebral congestion, In delirium it is used for the same purpose, and 
may be given to maniacs who are suffering from an attack of cerebral 



CYANIDE OF POTASSIUM. 163 

congestion or obstinate constipation, owing to the smallness of its 
dose and rapidity of action. The dose is 1 drop placed on the tongue 
with sweet oil or given in emulsion or in pill. It ought never to be 
used when there is any irritation of the stomach or bowels. As a 
counter-irritant it is sometimes applied over a tender nerve, or to the 
chest in the treatment of bronchitis, in the proportion of half-and- 
half with sweet oil. Thus applied it may be absorbed and cause 
purging. The treatment of poisoning by croton oil is identical with 
that of gastro-enteritis. (See Gastro-enteritis.) Linimentwn Crotonis 
is a preparation of the B. P., which is employed as a counter-irritant 
liniment for sprains and in muscular rheumatism. 



CUBEBS. 

Cubebs (Cubeba, U. 8. and B. P.) are the unripe fruit of Cubeba 
Officinalis, a plant of Java. They consist in wrinkled or rough black 
bodies, about the size of small peas, and have an aromatic pungent 
taste. They contain a volatile oil, cubebic acid, and cubebin. The 
drug should not be kept in powdered form, as it loses its powers, but 
should be powdered as needed. Overdoses of cubebs cause gastro- 
intestinal and gen i to-urinary inflammation. 

Therapeutics. — Cubebs are used in the advanced stages of gonor- 
rhoea where a tendency to a chronic discharge is present. Some sur- 
geons have used them in the early stages as an abortive treatment, but 
this is a bad practice. In cold in the head the powdered berries may 
be snuffed up the nostril, provided that the stage of secretion is well 
established. They ought not to be used before this stage. In the 
treatment of chronic or subacute bronchitis the oleoresin of cubebs 
is very useful in some cases (see Bronchitis), and in the form of cubeb 
cigarettes the drug is much used as a remedy for hoarseness due to 
subacute laryngitis. 

Administration. — Cubebs may be given in powder in the dose of 
10 to 60 grains, in the fluid extract (Extr actum Cubebw Fluidum, 
U. 8.) 10 to 30 drops, and in the form of the tincture (Tinciura 
Cubebw, U. 8. and B. P.) in the dose of 10 drops to \ an ounce. 

The close of the oleoresin (Oleoresina Cubebw, U. 8. and B. P.) is 
2 to 20 drops three times a day, and it may be given in capsules or 
emulsion. The troches of cubebs (Trochisci Cubebw, U. 8.) are used for 
the relief of pharyngitis of a chronic type. The dose of the oil (Oleum 
Cubebw, U. 8. and B. P.) is 5 to 20 minims. 



CYANIDE OF POTASSIUM. 

Cyanide of potassium (Potassii Cyanidum, U. 8. and B. P.) is used 
in the same way and for the same purpose as hydrocyanic acid. (See 
Hydrocyanic Acid.) The dose is ^ to -^ of a grain. 



164 DRUGS. 

The following prescriptions may be used in cases suffering from 
bronchitis or phthisis accompanied with excessive cough : 

J£. — Potassii cyanid gr. ij. 

Morphinse sulph. . . . . . gr. j. 

Acid, sulph. arom. . . . . . f ^ ij. 

Syr. pruni virginianse . . . q. s. ad f ^ iij . M. 
S. — Teaspoonful three times a day. 

Or as follows : 

R. — Potassii cyanid gr. ij. 

Amnion, chloridi ^ij. 

Acid, hydroehlor. dil f Z j. 

Elix. calisayse . . . . q. s. ad fjfiij. M. 

S. — Teaspoonful three or four times a day. 



DERMATOL. 

(See Bismuth Subgallate.) 

DIGITALIS. 

Digitalis, U. S., is obtained from the leaves of Digitalis Purpurea, 
or foxglove of the second year's growth. The leaves are official in 
the B. P. as Digitalis Folia. It contains a number of substances, 
none of which act as does the crude drug. In other words, all these 
compounds must act together to be therapeutically active. Among 
the substances so far isolated from digitalis by chemists may be 
named digitalin, digitalein, digitoxin, digitin, and digitonin. Several 
of these are simply compounds of the others. Digitalin, so-called, 
occurs in two forms, amorphous and crystalline. The crystalline digi- 
talin (French) is largely digitoxin, while the amorphous is composed 
of digitonin, digitalein, and digitalin. A pure digitalin has been iso- 
lated, but it is not on the market. Digitoxin and pure digitalin are 
the two most active principles yet found. JNone of these substances 
should be used in medicine to take the place of digitalis. 

Physiological Action. — Digitalis is apt to irritate mucous mem- 
branes which are already slightly out of order, and for this reason 
should not be given by the mouth in cases of gastritis and allied states. 

Nervous System. — The action of digitalis upon the nervous sys- 
tem is only manifested when poisonous doses are used. Small toxic 
doses decrease reflex action by stimulating Setschenow's reflex inhibi- 
tory centres in the medulla, and finally by depressing the spinal cord. 
Convulsions are sometimes seen as a result of the disorder of the cir- 
culation at the base of the brain, owing to the disturbed and abortive 
action of the heart. Finally, the motor nerve-trunks themselves are 
depressed. 

Circulation. — Upon the circulatory system digitalis exerts its 
chief influence. In moderate amounts it increases the pulse force and 



DIGITALIS. 165 

arterial pressure, slows the pulse, and increases the size of the pulse 
wave. The increase of pulse force is due to a stimulating influence 
exercised upon the cardiac ganglia and the muscular fibres of the 
heart, the rise of arterial pressure is caused by this increased pulse 
force and pulse volume, and by a stimulation of the vasomotor centre 
and the muscular coats of the bloodvessels, whereby a contraction 
occurs in the walls of the arteries and arterioles. The slow pulse is 
produced by stimulation of the pneumogastric centre and the periph- 
eral ends of the vagus nerves. The increase in the volume of the pulse 
is due to this influence on the vagi, for, the pneumogastric nerves being 
stimulated, the diastole of the heart is more full and complete and oc- 
cupies a greater length of time. The result of this delay is that the 
ventricles become thoroughly distended, and on contracting drive out 
a much larger wave of blood through the aorta than is normally sent 
out. This is important to remember when using the drug in heart 
disease and other states. While we do not know that the vagi are the 
trophic nerves of the heart, we have a large amount of evidence in 
favor of such a view, and it has long been thought that digitalis was 
not only a heart stimulant but a heart tonic. If the trophic nerves of 
the heart are stimulated by digitalis it at once becomes evident that it 
is a doubly useful remedy. 

The action of digitalis upon the heart is a double one, in that it 
creates two opposing forces. By the action on the heart muscle it 
steadily strives to cause contraction or systole of the ventricles ; by 
the action on the vagi it equally steadily struggles to produce diastole 
or dilatation of these cavities. In medicinal close neither of these 
tendencies gets the upper hand, for both are equally excited, so that 
now increased systole occurs, now increased diastole. 

In poisoning, on the other hand, or in instances where overdoses 
have been given, so much stimulation is caused that the heart beats 
now slow, now fast, now strong, now weak : slow when the vagi 
overcome systole, fast when systole overcomes the vagi ; strong w T hen 
systole escapes from the inhibitory nerves, weak when the ventricles 
can scarcely contract because the vagi are holding the ventricles open. 
In man we frequently see this irregular pulse replaced by an exceed- 
ingly rapid pulse, which is shuttle-like in character. This is probably 
due to a depression of the peripheral ends of the vagus nerves. In 
the frog digitalis nearly always causes, when given in full doses, an 
arrest of the heart in systole, while in man and the higher animals 
the arrest is in diastole. 

If the patient, who has taken a poisonous dose, be raised up he may 
drop dead, owing to the still more active disturbance of the balance of 
power caused by the calls for blood due to the erect position, and under 
these circumstances the heart beats so fast that it has not time to get 
enough blood into it to pump anything out, or so feebly that the dilated 
ventricles are never emptied. Finally, a fall of arterial pressure en- 
sues, not because the vasomotor system is depressed, but because the 
heart cannot pump out enough blood to fill the bloodvessels. 



166 DRUGS. 

Kespiration — Digitalis has almost no effect on this function, un- 
less the amount be poisonous, when respiration is slowed. 

Temperature. — Upon the normal bodily temperature digitalis has 
little or no effect in medicinal dose. In poisonous dose it lowers tem- 
perature. In fever the drug seems to cause a fall of a small amount 
with some constancy, but it can rarely be used for any antipyretic 
influence. High temperatures prevent digitalis from acting. This is 
an important point to be remembered in its therapeutic use. 

Kidneys, Tissue-waste, and Elimination. — Digitalis has 
almost no effect over the kidney structure itself, and does not to any 
extent stimulate the renal epithelium. The cause of the increased 
urinary flow produced in cardiac dropsy depends upon the removal of 
congestion of the kidneys and the increased arterial pressure and im- 
proved circulation brought about by the drug. 

Upon tissue-waste digitalis seems to have little effect, and there is 
still some discrepancy in the reports as to the amount of urea cast 
off under its use, some investigators saying it is increased, others that 
it is diminished. 

We do not know how the drug is eliminated, as chemists have 
never been able to find it in the urine. It is probably oxidized in the 
body. 

Poisoning. — The slow, full pulse, followed by the hobbling, dicrotic, 
shuttle-like pulse-beats, and the angry, tumultuous cardiac beat against 
the chest- wall, affords a combination of symptoms characteristic of the 
over-action of digitalis. The pulse may be full and slow when the 
patient is lying down, but at once becomes irregular on his sitting up. 

Often when the patient has by error received too much of the drug 
the finger can scarcely note any pulse at the wrist, while the ear placed 
over the heart shows it to be beating wildly, as though it would break 
out of the chest. It is important that the weak pulse at the wrist be 
not taken as the only guide as to the state of the patient, for this very 
reason. The physician should always consult the prsecordium before 
reaching an opinion as to the action of digitalis. 

As the poisoning progresses vomiting may come on, exophthalmus 
occurs, and a peculiar blue pearliness of the sclerotic coat of the eye 
is seen. Consciousness is generally preserved nearly to the last. 
Death may be put off for days, or occur in two hours, or even less. 
Headache is often a severe symptom. 

Treatment of Poisoning. — Tannic acid is to be given as a chemi- 
cal antidote ; emetics and the stomach-pump are to be used, the former 
only when the drug has not yet been absorbed, for if the heart is much 
affected emetics are dangerous. External heat is to be applied, partic- 
ularly about the abdomen ; the maintenance of a horizontal position 
must be insisted upon, and the use of tincture of aconite, as the physio- 
logical antidote, resorted to. 

Therapeutics. — Much unfortunate misunderstanding concerning the 
action of digitalis has arisen, and while some call it a circulatory 
stimulant, others think it a circulatory depressant. The first class base 
their belief on the signs of increased arterial pressure and cardiac power, 



DIGITALIS. 167 

the others on the fact that it slows and steadies an irritable, rapidly- 
acting heart, and they overlook the other signs. Digitalis is a cardiac 
stimulant, and not a depressant. The quieting of irritability by it is 
the quietness produced by the drink of whiskey or coffee taken by the 
speaker before mounting the platform, or the pugilist before he enters 
the ring, to steady his nerves and make him firm. If digitalis is used 
to decrease arterial tension its dose must be dangerously large. (See 
Physiological Action.) 1 

Digitalis is of value in all cases of cardiac disease where the condi- 
tion is one in which the heart fails to do its proper amount of work. 
If simple hypertrophy or excessive compensatory hypertrophy exists 
it is harmful. It is of less value in aortic regurgitation than in any 
other lesion, because the prolongation of diastole allows greater oppor- 
tunity for the blood to fall back into the ventricle. In some instances 
the drug does harm by over-distending the auricle through ventricular 
stimulation, and we can never tell before trying it which cases will be 
so affected. In cases where the heart is irritable, palpitation present, 
and indigestion not the cause of the trouble, digitalis is of service. 
(See Heart Disease.) 

In the second stage of pneumonia digitalis is invaluable (see Pneu- 
monia), and in exhausting fevers, in small doses, is of great service. 
In congestion of the lungs in the typhoid state, it will drive out the 
blood from the part congested and relieve stasis. 

In cardiac weakness from collapse, injury, poisoning or shock digi- 
talis is of service, particularly in aconite poisoning, where it is the 
physiological antidote. Owing to the slowness of its action it should, 
however, be preceded by ammonia and alcohol where the need is 
pressing. In muscarine poisoning digitalis is the antidote. 

As a diuretic, digitalis may be used where the kidneys are congested 
and the circulation is sluggish. Where the renal structure is dis- 
eased, other drugs should take its place, or it should be combined with 
more active renal remedies, such as squill or caffeine, or in very chronic 
cases with compound spirit of juniper. 

In some cases a cumulative action occurs which consists in the 
failure of the drug to appreciably influence the circulation for some 
days, only to exert all its power suddenly and produce symptoms of 
poisoning. This is particularly apt to occur where the removal of 
ascites or dropsy takes place by tapping after the drug has been taken 
for a long period. It is thought that the sudden withdrawal of press- 
ure upon the great vascular trunks of the body-cavities causes the 
absorption of the drug with the juices of the tissues where it has 
remained in inactivity. 

The contra- indications to the use of digitalis are marked atheroma 
of the bloodvessels, aneurism, apoplexy, and any state of arterial ex- 
citement. 

Administration — The official preparations of digitalis are the tinc- 
ture (Tinctura Digitalis, U. S. and B. P.), dose 10 to 20 drops ; the 

1 It is absolutely necessary for the student to turn to the article on heart disease 
and to read it carefully in order to understand the action of digitalis in disease. 



168 DKUGS. 

infusion (Infusum Digitalis, U. 8. and B. P.), 1 teaspoonful to 4 tea- 
spoonfuls ; the fluid extract (Extractum Digitalis Fluidum, U. S.), dose 
1 to 2 drops ; the abstract (Abstraction Digitalis, U. 8.), J to 1 grain ; 
the extract (Extractum Digitalis, U. 8.), J of a grain ; and the powdered 
digitalis leaves (Digitalis Folia, B. P.), dose 1 to 4 grains, generally 
given in a pill. The tincture is the preparation most commonly used, 
and is most satisfactory, although the infusion has been thought of 
greater value, without any good reason. 

The dose of digitalin, which ought not to be used, is -^ of a grain. 



DIURETIN. 

(See SODIO-S ALIO YL ATE OF THEOBROMINE.) 

ELATERIUM. 

Elaterium, B. P., is a sediment obtained from the juice of the Ecballium 
Elaterium, or squirting cucumber. It appears in small, easily broken, 
thin, grayish-green flakes, and has a bitter taste. Elaterium is not 
official in the U. 8. P., but its active principle, elaterin (Elaterinum, 
U. 8. and B. P.), is official. Notwithstanding this fact, the crude 
preparation is largely used. 

Physiological Action.-— Elaterium is a very decided irritant to all 
mucous membranes, and even to the hands of those who handle it. 
Its chief effect in man is to cause profuse watery stools, but for some 
unknown reason it rarely acts upon animals in this manner. 

Therapeutics. — This drug is the best hydragogue purge which we 
have, causing very large watery passages, but not producing much pain 
when used in proper dose. For this reason it is useful in the treatment 
of local serous effusions, as in pericarditis and pleurisy and in dropsy 
and ascites. It ought never to be used in cases of marked exhaustion, 
and may be advantageously followed, soon after it acts, by alcoholic 
stimulants. In urcemia, with dropsy, it is thought to aid in the elim- 
ination of the poison by the bowel. In cerebral congestions or effusions 
the drug will often be of service. 

In poisoning by elaterium the symptoms are those of violent 
gastro-enteritis, and must be treated accordingly. (See Gastro-enteritis.) 

Administration. — The dose of elaterium is \ of a grain, given in a 
freshly made pill. Elaterin is best given in the dose of from -g 1 to 
•jig- of a grain, as follows : 

R . — Elaterini gr. iv. 

Alcoholis fjiv. M. 

Dissolve by gentle heat. S. — Half a drachm contains T \ grain, or one full dose. 

The official preparations of elaterin, the active principle of elaterium, 
are Trituratio Elaterini, U. 8. (elaterin 1, sugar of milk 9), given in the 



ERGOT. 169 

dose of J to { grain, and Pulvis Elaterini Compositus, B. P. (elaterin 
1, sugar of milk 39), dose 1 to 5 grains. 



ERGOT. 

Ergota, U. S. and B. P., is derived from the spawn or mycelium of 
the fungus known as Claviceps Purpura, which growns in the flower 
and replaces the grain in common rye or Secede Cereale. 

Many so-called active principles have been isolated by chemists, and 
named ecbolic acid, ergotic acid, sclerotinic acid, and ergotin. None of 
them represent the entire drug, the nearest in its approach being ergotin, 
and ergotin is not an isolated principle, but a combination of principles. 
Kobert teaches that there are three principles, namely, ergotinic acid, 
cornutine and sphacelinic acid, and that cornutine is a true alkaloid. 
Tanret on the other hand denies the existence of cornutine as an alka- 
loid. 

Physiological Action. Nervous System. — Upon the nervous sys- 
tem ergot exercises little, if any, effect. In chronic poisoning, due 
to eating rye-bread contaminated by ergot, we sometimes see what is 
known as spasmodic ergotism due to disturbances of nervous system. 

Circulation. — Ergot when injected into the circulation causes a 
primary fall of arterial pressure, followed by a rise. The dominant 
action is represented in the rise. This rise is due to a stimulation of the 
vasomotor centres, but the primary fall is caused by its direct depres- 
sant effect upon the heart muscle, resulting from contact on the part of 
the drug en masse with the heart. 

If the dose be very large the fall of pressure is never recovered 
from, and progressive paralysis of the vasomotor apparatus and heart 
occurs. 

Uterus and Unstriped Muscular Fibre. — It is commonly 
taught that ergot acts as a stimulant to the uterine muscle, and causes 
contraction of unstriped muscular fibres everywhere, but the careful 
studies of Hemmeter during the past few months have proved that 
the drug also causes uterine contractions by stimulating the centres in 
the lumbar portion of the spinal cord. 

On the uterus ergot in full medicinal dose exerts its influence — not 
increasing the normal pains of labor, but causing a tetanic, tonic, un- 
yielding uterine spasm which drives all before it. In very small doses 
it may assist the normal contractions without causing them to become 
tetanic. 

Chronic Poisoning". — Two forms of poisoning, from the prolonged 
use of ergotized rye-bread, sometimes occur. One is characterized by 
spasmodic muscular contractions, the other consists in the formation of 
gangrenous sloughs. 

Therapeutics. — Ergot is given to parturient women for the preven- 
tion or cure of post-partum Jiceraorrhages. For the prevention it should 
be given to the woman by the mouth just as the head of the child is 
about to slip over the perineum, and not before. When administered 



170 DRUGS. 

to stop a haemorrhage already flowing the doses should be large, as 
much as 1 to 2 drachms of the fluid extract or 2 wineglassfuls of the 
wine of ergot. Ergot should never be given in the early stages of 
labor, but this rule may, under certain conditions, be modified. If 
uterine inertia comes on in the course of a normal labor and quinine 
cannot be used for any reason, small doses of ergot may be employed. 
These small doses do not cause a constant tetanic uterine contraction, 
but simply bring on the "to-and-fro" movements. By small doses the 
writer means from 5 to 20 drops of the fluid extract. 

If the canal is obstructed ergot should never be employed, and 
unless the os uteri is well dilated should not be given in any dose. 

In post-partum hemorrhage it may be well to give a solution of the 
aqueous extract of ergot hypodermically. The extract should be 
rubbed with the proper amount of water (parts 1 to 5), and filtered 
through a fine aseptic handkerchief to get rid of foreign bodies before 
it is injected. 

When ergot is given care should be taken that the uterine cavity be 
clear of all clots or placental fragments, lest the closure of the os uteri, 
under the influence of the drug, imprison these harmful materials. 

In hcemorrhages from the lungs and kidneys, or other unapproachr 
able parts, ergot is thought by some to be very useful when given by 
the mouth, but it is probable that it rarely achieves any real good. 
Particularly is this the case in pulmonary haemorrhage, since the vaso- 
motor system practically does not exist in the pulmonary vessels, and 
the increased pressure caused by the ergot in the general systemic cir- 
culation may increase the pulmonary leakage. The truth is that in 
pulmonary haemorrhage very little real good can be obtained by internal 
medication. 

In epistaxis, monorrhagia, and metrorrhagia, and in some cases of 
night-sioeats, it is of service. In hypostatic, pulmonary, and other con- 
gestions it is useful, particularly if employed with digitalis. 

In dysenteries with bloody stools and in serous diarrhoea ergot some- 
times does good. 

Some persons suffer from vertigo associated with hyperesthesia of 
the scalp and headache. Belief can often be obtained by the use of 
20 drops of the fluid extract of ergot and 5 to 10 grains of bromide of 
potassium three times a day. 

Ergot has been used very largely in the treatment of uterine fibroids 
as an expulsive remedy and cure. It is only of value in those cases 
where the growths are just beneath the mucous membrane. By the 
contractions of the uterine muscular fibres the blood-supply of the 
growth is decreased, the recurring haemorrhages cease, and the tumor 
is finally expelled, having really sloughed out of its bed. This method 
is inferior to the knife, and very painful and prolonged. Large 
growths cannot be so treated. Ergot is sometimes useful in the treat- 
ment of bleeding haemorrhoids, and it has been given with success in 
diabetes insipidus. 

Administration. — Ergot is official in the U. S. P. as the fluid extract 
{Extractum Ergotw Flwidiim), dose J to 1 drachm; the solid extract 



ETHEK. 171 

{Extradum Ergotce), dose 5 to 20 grains ; and the wine ( Vinum Ergotce), 
dose 2 to 4 drachms. Bonjean's ergotin is made by a special process, 
and it or the solid extract can be given hypodermically in the manner 
already described. The B. P. preparations are Extradum Ergotce 
IAquidum, dose 10 to 30 minims ; Infusum Ergotce, 1 to 2 fluidounces ; 
Tindura Ergotce, 10 minims to 1 fluidrachrn. Ergotin {Ergotinum, 
B. P.) is given in the dose of 2 to 5 grains. Injedio Ergotina Hypo- 
dermica, B. P. (ergotin 1, camphor water 2 parts) is given, in the dose 
of 3 to 10 minims, by subcutaneous injection. 



ERIGERON, or FLEABANE. 

Oil of Erigeron {Oleum EtHgerontis, U. S.) is a yellowish, volatile oil 
of a peculiar, not bad, taste, closely resembling turpentine. It is by 
far the best remedy which we have for the treatment of passive uterine 
oozing, or a " show/' as it is sometimes called. 

In epistaxis and other haemorrhages of a subacute type it is quite 
useful. In some instances it is used in place of copaiba and cubebs in 
the later stages of gonorrhoea. It is best given in capsule or on sugar, 
in the dose of 10 to 30 drops after meals, or oftener if needed. 



ETHER. 

Sulphuric Ether is official as JEther, U. 8. and B. P., aud jEther 
Fortior, U. S. Pure Ether {JEther Purus, B. P.) is free from alcohol 
and water. Ordinary ether is not generally used as an anaesthetic, but 
for the abstraction of oils and for other pharmaceutical purposes. It 
is made by the action of sulphuric acid on ethylic alcohol, and is 
sometimes called in consequence ethyl oxide. Ordinary ether contains 
about 74 per cent, of ethyl oxide and 16 per cent, of alcohol, with a 
little water. On the other hand, the stronger ether contains about 94 
per cent, of ether oxide and only 6 per cent, of alcohol, with water. 
Both preparations boil when held in a test-tube, if a piece of broken 
glass is added to the liquid. The stronger ether boils much more 
vigorously than the weaker under these circumstances. 

Ether possesses a peculiar penetrating odor, a hot burning taste, and 
is a colorless, volatile, and very inflammable liquid. For this reason it 
should never he held near a fire or light, and, as its vapor is heavier 
than air, any light in the room should be above the patient, not below 
him. No light should be held nearer than five feet. 

Physiological Action. — The action of ether on the animal organism 
is very rapid and powerful, but temporary. Except for the rapidity 
of its effects it is very much like that of alcohol. When applied to 
the skin it causes intense cold by its evaporation, and may be used by 
means of a spray to benumb or locally freeze a part. 

Upon mucous membranes ether acts as an irritant, and causes, when 
first inhaled, great irritation of the fauces and respiratory tract, so 



172 DRUGS. 

that temporary arrest of respiration is not uncommon. The face be- 
comes suffused and red and the conjunctiva injected, but a stage of 
quiet succeeds the primary stage of struggling which arises from the 
choking sensations. During this period the breathing is generally 
full and deep and the pulse rapid but strong, while the ocular reflexes 
are at its beginning intact. Following this stage a second period of 
struggling comes on, in which the patient may become absolutely un- 
controllable except by brute force. Yelling, shouting, screaming, 
cursing or laughing and crying may be prominent symptoms, and the 
individual is pugilistic, caressing or ill-tempered, as the case may be. 
If the drug is now pushed a condition of total anaesthesia is attained, 
and quietude takes the places of the struggles. This is the time for 
the operation to be carried on, for if it is attempted in the earlier 
stages the struggles of the second stage prevent any operative pro- 
cedures (see Therapeutics below). It is not proper to push the 
muscular relaxation to complete flaccidity, as this endangers the 
respiration. 

Nervous System. — Ether acts first on the brain, then on the 
sensory centres of the spinal cord, then on the motor centres, then on 
the sensory centres of the medulla oblongata, and, finally, upon the 
motor centres of the medulla, thereby producing death from respira- 
tory failure. Upon the nerve-trunks it exerts no effect unless it is 
directly applied to them. Ether does not act by influencing the blood, 
coagulating the protagon of the nervous system, or by any other de- 
structive influence. It simply puts aside, for the time being, the vital 
functions of the parts affected by it. 

Circulation. — Ether is one of the most diffusible and rapid 
cardiac stimulants which we possess, and is correspondingly fleeting 
in its effects. It increases the pulse-rate and force by stimulating the 
heart and by increasing the activity of the vasomotor centres. In 
overdoses it acts as a cardiac depressant, but only when the amount is 
very large. 

Respiration. — When ether is first inhaled it often causes an arrest 
of respiration. According to Kretzschmar, this is due to an irritation 
of the trifacial nerve, which causes a reflex spasm of the glottis, and 
not to irritation of the peripheral vagi in the lungs. This is only 
partly true, for the author has proved that section of the vagus nerve 
prevents this occurrence, so that both the vagal and trigeminal irrita- 
tion are responsible for the arrest. 

Upon the respiratory centre ether acts as a powerful stimulant in 
ordinary amounts ; in overdose it paralyzes this part of the nervous 
system. 

Temperature. — Prolonged etherization lowers the bodily heat 
very greatly. That of the dog may be lowered some 9° F. in an 
hour if the drug be pushed, and as great a fall has been known as 
4° F. in man (Hare). The fall is partly due to the depression of the 
nervous system and the chilling of the body and lungs by the evapora- 
tion of the drug. 



ETHER. 173 

Elimination. — Ether escapes from the body by the lungs and 
kidneys. 

Untoward Effects — Ether, while safer than chloroform, is not ab- 
solutely devoid of all dangerous effects. Sometimes when the drug 
is pushed too strongly deep cyanosis with pulsation of the jugular 
veins shows deficient oxidation and cardiac distention. In other and 
very rare instances sudden cardiac failure has occurred, or total arrest 
of respiration ensued. In nearly all cases of sudden death from ether 
grave kidney or other lesions have been present, and have been found 
at the autopsy. 

One of the earliest signs of the over-action of ether is the failure of 
the diaphragmatic movement, followed by that of the lower part of the 
chest, then of the upper part and then of the cervical muscles. 

In patients under ether the movement of the diaphragm is an ex- 
ceedingly interesting study, for before the condition known as surgical 
anaesthesia is developed, while there is still some rigidity, and the 
throat reflex is not completely abolished, the contractions of the dia- 
phragm are frequently so violent that unless the laryngeal opening 
be absolutely free, the intercostal spaces are depressed and the ab- 
dominal contents thrust violently downward and outward. Just so 
soon, however, as the chin is pulled forward and a free access of air 
is allowed, the abdominal displacement, though it is still present, 
is not so great, and the chest movement is no longer reversed. As 
the ether is pushed, the respiration becomes purely thoracic, the dia- 
phragm no longer taking part in the respiratory cycle, or becoming 
so relaxed that it allows the chest on expansion to aspirate the 
abdominal viscera upward, as is shown by the retraction of the belly 
walls at a time when they should normally expand with the thorax 
in inspiration. This observation would seem to point to the fact that 
the primary stimulant action of ether upon the respiratory apparatus 
is particularly felt by those centres which govern the movements of 
the diaphragm, and that, as this is the case, these centres later on 
are the first to feel the paralyzing effect of still larger amounts of 
the drug. 

These facts give us, therefore, yet another danger-signal during the 
administration of the ether, and the integrity of the diaphragmatic 
function, as represented by the movement of the belly walls, should 
be as carefully observed as are the thoracic excursions, the character of 
the pulse, or the condition of the pupil. The rule may therefore be 
laid down that when the diaphragm ceases to act, anaesthesia has 
been carried to its extreme legitimate limit, and that the use of an 
anaesthetic after this time must be carried on with the greatest care 
and watchfulness. 

The diaphragm is the first part of the respiratory mechanism to 
yield to respiratory paralysis. In death from any cause, the progress 
of failure of respiration will, in the vast majority of cases, be denoted 
by a failure on the part of the diaphragm primarily, with compensa- 
tory excursions of the chest ; and it is also to be noted that as the 
chest movements fail, the accessory muscles of the neck come into 



174 DRUGS. 

play. These muscles in time cease to act, the hyoidean group lose 
their point d'cuppui, the chest remains motionless, the lower jaw is 
dropped, and the scene is closed by a few gasps in which the muscles 
of the neck may be the chief factors. 

The treatment of accidents during etherization consists in the with- 
drawal of the ether, the use of artificial respiration, and the placing 
of the body, if the face is pale, head downward. On the other hand, 
if the face is flushed and cyanotic it indicates respiratory, not cardiac, 
failure, and this position is not to be resorted to. The physician 
should also employ hypodermic injections of strychnine, atropine, and 
digitalis, or more rarely an intravenous injection of ammonia, which is 
more dangerous but better than the others in a pressing emergency, 
because it is more rapid in its action. Ether is often given hypoder- 
mically under such circumstances, and seems to do good, but its use is 
a bad practice, as, if the heart or respiration is already depressed by 
ether, the use of still more of the drug simply makes matters worse. 
The cases in which such a line of treatment is followed by good results 
are those in which the failure of respiration is not due to a saturation 
of the body with ether, but to asphyxia produced by mechanical inter- 
ference with free breathing, as, for example, the presence of mucus in 
the air-passages or a too close application of the towel to the face. In 
such cases the hypodermic injection of ether causes so much local pain 
and irritation as reflexly to call up respiratory movements as well as 
to directly stimulate the respiratory centre to greater effort. 1 Alcohol 
ought not to be used if the other drugs named can be obtained, because 
alcohol is so nearly allied physiologically and chemically to ether. Fric- 
tions, hot applications, and artificial respiration should be practised 
(see article on Asphyxia). 

As ether is at hand it may be dashed on the chest and abdomen to 
cause reflex inspiration in lieu of cold water, which wets the clothes 
and does not evaporate. 

In some cases great nausea and vomiting follow the use of ether. 
This can generally be prevented by the proper use of food before the 
operation (see Therapeutics), and by the use of cracked ice and small 
doses of aconite after the operation. (See Vomiting.) Severe bron- 
chitis may occur in invalids and children after the inhalation of ether. 

Therapeutics. — Ether is used chiefly as an anaesthetic by means of 
inhalation. The method consists in forming a cone out of a towel 
and a piece of paper and placing a small sponge in its end. Upon 
this sponge the ether is poured and the large open mouth of the cone 
is placed over the face. If this be done suddenly the sensation of 
suffocation is generally so great as to cause fright and struggling, 
which is inadvisable. The better way is to hold the cone at some dis- 
tance from the face and gradually bring it nearer as the effects of the 
ether are felt. After partial anaesthesia is attained the cone should be 
placed closely over the face and the vapor be pushed in as concentrated 

1 As consciousness is not necessary to the carrying out of a reflex action, this is 
perfectly possible and probable. 



ETHYL BROMIDE. 175 

a form as possible, whereas when chloroform is used it should be well 
mixed with a great amount of air. Care should be taken that the 
ether does not get into the eyes of the patient, either in vapor or 
liquid form, owing to the irritation which it will set up. To prevent 
this a thin piece of muslin wet with water will be found of service if 
placed over the eyes. A large number of ether inhalers are employed 
in preference to the towel, of which the best is probably that known 
as the "Allis Inhaler." 

When ether is to be given, no food ought to be allowed the patient 
for twelve hours preceding its use, except a little milk or tea an hour 
or two before the operation, in order to avoid vomiting during and 
after this procedure. The patient should not be allowed to retain any 
tobacco or false teeth in the mouth, as they may slip into the larynx 
and cause death while the anaesthetic is being given. 

Locally ether may be used in an atomizer spray as an anaesthetic 
owning to the cold produced by its evaporation. Thus it is particularly 
useful in cases where thoracentesis or paracentesis abdominis is to be 
performed, and also in cases of superficial neuralgia, where the be- 
numbing of the nerve often effects a permanent cure. 

Internally, by the stomach, ether is very useful in colic, although 
for flatulence of adults and children Hoffmann's Anodyne is a more 
agreeable remedy. In cases of collapse the hypodermic and gastric 
use of ether make it of great service when cardiac action is very feeble, 
and it will give relief by inhalation in some of these cases more rapidly 
than the nitrite of amyl. 

In hiccough a few r inhalations of ether will often stop the spasmodic 
movements, and local muscular spasms can be relieved in this way. 

Ether may be used to produce muscular relaxation when the sur- 
geon attempts to reduce a strangulated hernia by taxis. 

In cases wliere cod-liver oil cannot be digested, ether may be given 
in 20-drop doses in ice-water or capsule, either w r ith, or some minutes 
after, the oil is taken, to aid in its digestion and absorption. The 
time of its use should be that at which discomfort is apt to come on, 
and not at any stated moment. 

Administration. — Ether should be given, when used internally, in 
ice-cold water, or, better still, in capsules, in the dose of 30 drops to 
J ounce. If cold water is not used to dilute it, so great is the irrita- 
tion of the fauces produced by the fumes of the ether that deglutition 
is impossible. 

Contra-indications. — Ether should not be used by inhalation in 
bronchitis, acute nephritis, peritonitis or gastritis, in aneurism, or in 
the presence of marked vascular atheroma. 



ETHYL BROMIDE. 

Bromide of Ethyl is obtained by distilling a mixture of alcohol, 
sulphuric acid, and bromide of potassium, and is a colorless fluid of 
neutral reaction, having a pleasant odor resembling chloroform. It 



176 DRUGS. 

evaporates with great rapidity, and any sample which does not do this 
is to be discarded. Poured on the hand it should leave no fatty feel- 
ing. It should be remembered that the drug is decomposed by sun- 
light and when in contact with pure air. In the presence of lamp- 
light the fumes form bromal hydrate and bromine. The drug should 
be kept in dark-glass bottles. The physician should distinctly separate 
in his mind bromide of ethyl from bromide of ethylene. The latter is 
a chemical product possessing very dangerous properties, and should 
never be used in medicine. There is reason to believe that unfavor- 
able symptoms follow the use of bromide of ethyl only when the drug 
is impure or is improperly used. 

Therapeutics. — Bromide of ethyl is a useful anaesthetic for short 
operations, such as opening boils or abscesses, or for the relief of 
the pain in other brief surgical procedures. Originally introduced into 
general use in this country by Levis, it has been found unsuited to 
major surgical cases because if continued for a long time it seriously de- 
presses the respiration. Bromide of ethyl has been found of the great- 
est value by Montgomery, of Philadelphia, as an anaesthetic in labor 
and for minor gynecological operations in office practice. He finds that 
the patient may be allowed to inhale the drug from a Hawley inhaler, 
for as soon as she has had enough to produce anaesthesia the inhaler 
drops from her hand. The patient is also more obedient to the physi- 
cian's directions, because of the fleeting influence of the drug, than 
when chloroform or ether are taken, and it is not so apt to cause post- 
partum hemorrhage through uterine relaxation. 

A very great advantage possessed by bromide of ethyl is the 
rapidity of its action. A few whiffs are generally all that is needed to 
cause anaesthesia. It rarely produces disagreeable effects. Cases of 
sudden death under its use are, however, on record, and in some in- 
stances nervous twitchings and even tetanic spasms have been known 
to follow its employment. These symptoms are, however, fleeting, and 
generally of little importance. Nausea and vomiting rarely follow its 
employment, but it is apt to leave an unpleasant garlic-like taste in 
the mouth, and a similar odor of the breath is frequently noted for 
several days after its use. 

Administration. — Bromide of Ethyl should be admiuistered but for 
a brief period, but when taken should be inhaled freely. It cannot 
be given carelessly with good effect. If a good sample is employed 
45 minims to 3 drachms is a sufficient amount. This quantity should 
be used at once instead of added to the inhaler drop by drop, as in the 
case of chloroform, and the cloth or inhaler should be held close to the 
mouth and nose instead of at a little distance, as is often necessary 
with other anaesthetics. 

ETHYL IODIDE. 

This is a colorless, non-inflammable liquid, which really should be 
called hydriodic ethyl. Ethyl iodide must be kept in dark-colored 
bottles in a dark place to prevent it from undergoing decomposition. 



EUCALYPTUS. 177 

It is very volatile and the fumes arising from it are slightly pungent, 
but not irritating in ordinary amounts. Unfortunately the odor is 
disagreeable to most persons. 

Physiological Action. — Very little is known of the general physio- 
logical action of iodide of ethyl, and the drug would be a good one 
for laboratory investigation. It does not produce anaesthesia except 
in very large amounts. 

Therapeutics. — Iodide of ethyl is used in medicine entirely by in- 
halation for the treatment of subacute or chronic catarrh of the air- 
passages and for the purpose of rapidly impressing the system with 
iodine for alterative purposes, as it is the iodine in the remedy which 
produces the curative effects desired. In catarrhal states of the bron- 
chial tubes the stimulating effect of the iodine causes free secretion 
and prevents abnormal thickening of the mucus and dilatation of the 
air-passages. For this reason iodide of ethyl is supposed to be of 
service in asthma and its resulting emphysema. Very recently Bar- 
tholow has recommended this drug in the treatment of pneumonia. It 
is said by that writer to be particularly useful in the later stages of this 
disease, as it aids in producing resolution, but the author has never 
seen it produce much effect. 

Administration. — Ten to twenty drops may be placed upon a hand- 
kerchief and inhaled, or a small vial filled with the drug may be held 
in the hand under the nostrils. Under these circumstances the heat 
of the hand sets free the necessary amount of vapor. 



EUCALYPTUS. 

Eucalyptus, U. S., is the leaves of the Eucalyptus Globulus or Blue 
Oum tree, a native of Australia, but grown at present all over the 
world. Their chief medical constituent is the Oil of Eucalyptus 
(Oleum Eucalypti, U. S.), from which is derived eucalyptol, which is a 
camphorous body obtained by redistillation with caustic potash or 
chloride of calcium. The oil of eucalyptus and eucalyptol are used 
for the same purposes, but the latter is the refined product of the 
former. 

Physiological Action. — Locally applied the oil is a decided irritant. 
Ten to twenty drops taken internally cause slight stimulation, fol- 
lowed by a sense of calm, while larger doses produce disturbed diges- 
tion and loose, oily-odored stools. The pulse is increased in frequency 
and force, and intense headache may come on. After very large doses 
there is a fall in pulse force, bodily temperature, and strength of limb, 
and the respirations are decreased. A peculiar loss of sensation in the 
lower limbs may occur. If death takes place it is due to respiratory 
failure. The drug is eliminated by the skin, kidneys, bowels and 
lungs. The urine may have the odor of violets, as it sometimes does 
after the use of oil of turpentine. 

The oil of eucalyptus has considerable antiseptic power. 

12 



178 DRUGS. 

Therapeutics. — Eucalyptus is used in malarial fever where quinine 
cannot be had or be borne by the patient owing to idiosyncrasy. In 
bronchitis in an emulsion or in capsule it is of great value in the later 
stages (see Bronchitis), and it may be used in the subacute forms of 
gonorrhoea in the same manner, since in its elimination by the lungs 
it acts locally upon the inflamed mucous membrane. The following 
prescription will answer : 

J£. — Olei eucalypti f ^j. 

Olei amygdalae dulc f 3J- M. 

Ft. in capsule no. x. S. — One t. d. after meals. 

Oil of eucalyptus is very useful in some forms of rheumatic head- 
ache or in headache dependent upon malarial fever. 

Eucalyptol is largely employed by rhinologists and others in lotions 
and other nasal applications. It may be used in solutions of fatty oils, 
but is insoluble in water, although it is soluble in alcohol and ether. 

Administration. — The extract (Extractum Eucalypti Fluidum, TJ. 8.) 
is given in the dose of 10 drops to 2 drachms. The oil (Oleum 
Eucalypti, TJ. 8. and B. P.) in the dose of 5 drops. The dose of euca- 
lyptol is 5 grains in capsule. 

TJnguentum Eucalypti is official in the B. P., but is seldom used. 

EUONYMUS. 

Euonymus, TJ. 8., or Wahoo, is the bark of Euonymus Atropurpureus, 
a native plant of the United States. It contains an active principle, 
euonymin. As a laxative its action is very slow and moderate, but it 
is thought to act particularly on the liver, and may be used when mild 
hepatic torpor is present. 

Administration. — The dose of the solid extract (Extractum Euonymi, 
TJ. 8.) is 3 to 10 grains. 

EUPATORIUM. 

Eupatorium, TJ. 8., Thorough w T ort or Boneset, is the leaves of the 
Eupatorium Perfoliatum, an American plant which is used as a simple 
bitter tonic and diaphoretic very largely in household medicine. The 
drug is generally given in hot infusion in cases of arrested menstrua- 
tion due to cold, or in the chill of a remittent or intermittent fever, and 
also for anorexia and debility. Its taste is very disagreeable, and in 
the dose of a pint of the cold infusion it has been used as an emetic. 
The fluid extract (Extractum Eupatorii Fluidum, TJ. 8.) is given in the 
dose of 30 drops to 1 drachm. 

EUPHORBIA PILULIFERA. 

This herb is sometimes called Snake-weed or Cat's-hair, and is a 
native of Australia and the West Indies, where, like stramonium, it 
grows profusely as a weed by the wayside. 



EUROPHEN. 179 

Physiological Action. — In toxic doses the drug kills small animals 
by failure of the respiration and circulation, these two vital functions 
being greatly affected by doses which exert no great influence on the 
rest of the body. In full dose it may cause some gastric irritation. 

Therapeutics. — Euphorbia pilulifera is one of the latest remedies in- 
troduced into medicine for the relief and cure of asthma, in which disease 
the results obtained, after other remedies fail, are very extraordinary 
if the reports of those who have given it a thorough trial can be ac- 
cepted without reserve. As yet we do not know the form of asthma 
which is most relieved by its use, and its employment is purely em- 
pirical. It has also been highly praised in the treatment of chronic 
bronchitis and emphysema. 

Administration. — Euphorbia pilulifera is best given in the form of 
the fluid extract in the dose of 30 drops to a drachm. The decoction 
is made by adding a " handful of stalks with the leaves on them to two 
quarts of boiling water and boiling down to a quart and a half." Of 
this decoction the dose is a small wineglassful three times a clay. (See 
Asthma.) 

EUROPHEN. 

Europhen is the result of the action of iodine on isobutylorthocresol 
in the presence of an alkali, and appears as a fine yellow powder, sol- 
uble in alcohol, ether, chloroform and oils, but insoluble in water. 
Introduced because it was hoped that it might prove a useful substitute 
for iodoform, its usefulness is still undecided, owing to the short time 
that it has been before the profession. One advantage claimed for it 
is that it parts with its iodine very slowly, and so is not apt to produce 
toxic symptoms as rapidly as does iodoform. For this very reason, 
however, it lacks the remedial power of the older drug, except in those 
instances in which a drying powder is needed which will keep the 
wound pure by making it too dry to be favorable to the growth of 
germs. When such an action is desired europhen possesses the addi- 
tional advantage of being five times as bulky as iodoform. In the 
treatment of tuberculous growths europhen has already proved itself 
very inferior to iodoform. Owing to its stability it fails to part with 
its iodine except in the presence of moisture, and is useless in dry-skin 
diseases. It has been found useful in scrojidoderm, ulcer of the legs, and 
lupus. Europhen may be employed externally in a salve of the strength 
of from 5 to 10 per cent., or with olive oil or lanolin. It can also be 
added to flexile collodion. The drug does not possess the odor of iodo- 
form, but experience will probably prove it to be more irritating than 
the latter drug. The internal dose is 1 to 3 grains in cases of syphilis. 
Europhen is incompatible with metallic oxides and the preparations of 
mercury, and also with the starch and zinc paste largely used by der- 
matologists. 



180 DRUGS 



EXALGINE. 

This substance is really niethyl-acetanilide and closely resembles 
acetanilide or antifebrin in its effects. It is giveu for the same pur- 
poses as is acetanilide and antipyrine, namely, for the relief of pain 
in locomotor ataxia and other nervous affections, but never as an anti- 
pyretic. When used, exalgine should be given night aud morning as 
a rule, so that the doses shall not be near together. The beginning 
dose should be from 2 to 4 grains, and not more than 12 grains should 
be given in 24 hours. It is stated by those who have used the drug 
that fever contra-indicates its employment. 

The following prescriptions will be found applicable : 

R. — Exalgini gr. xxx. 

Tincturae aurant. dulcis . . « . fgij. M. 
Ft. in sol. et adde 

Syr. aurantii f 5ss. 

Aquae menth. piperit. . . . q. s. ad 13 iv. M. 
S. — A tablespoonful night and morning. 

Or, 

R • — Exalgini gr. xxx. 

Spt. frumenti 13SS. M. 

Ft. in sol. et adde 

Syr. simp lieis • f.lj- 

Aquae, dest. . . . . . q. s. ad fjiv. M. 

S. — Tablespoonful night and morning. 



FLAXSEED. 

Flaxseed or Linseed (Linwn, U. S.), is the seed of Linum TJsitatissi- 
mum, or flax from which linen is made ; it is official in the B. P. as 
Lini Semina. It contains an oil and a mucilage, the first of which is 
largely used in the arts, and the second is sometimes employed in medi- 
cine. The oil (Oleum Lini, U. S. aud B. P.) is also used by physicians 
and pharmacists for various purposes. 

Therapeutics. — Flaxseed acts as a demulcent to inflamed mucous 
membranes, and is used largely in the treatment of acute cystitis, bron- 
chitis, gastritis, nephritis and similar states in the form of naxseed-tea. 
This is prepared by mixing together 3 drachms of flaxseed, not ground, 
30 grains of extract of liquorice, 10 ounces of boiling water, and allow- 
ing the mixture to stand one to four hours in a warm place. If the 
mixture is boiled the oil is set free and makes the dose disagreeable. 
This infusion may now be made more tasteful and useful by the addi- 
tion of a little lemon-juice and sugar and by the placing of from 1 to 
2 drachms of gum-arabic in the pitcher containing it. If the cough 
is excessive, a little paregoric may be added. Linseed oil is used some- 
times as a laxative in the dose of 2 ounces, and is said to be of service 
when so given in the treatment of haemorrhoids. 



GALLIC ACID; NUT-GALL. 181 

Flaxseed meal (Lini Farina, B. P.) is employed universally when 
moistened as a useful poultice. 

Under the name of Carron oil, an emulsion of lime-water and linseed 
oil, equal parts, is the standard application for limited or extensive 
burns. 

An infusion of linseed (Infusum Lini) and a poultice (Cataplasma 
Lini) are official in the B. P. 



GALLIC ACID. 

Acidum Gallicum (TJ. S. and B. P.) is prepared from powdered 
nut-galls by a somewhat complicated and prolonged process. It 
occurs in nearly colorless, long, needle-like crystals, which are soluble 
in 100 parts of cold water, 4 \ parts of alcohol, and 3 parts of boiling 
water. 

Physiological Action. — Gallic acid is an astringent but not a coagu- 
lator of blood. Locally applied in bleeding it is useless, but given 
internally iu haemorrhages which cannot be acted upon by the direct 
local application of tannic acid it is useful as a haemostatic. It is 
eliminated from the body by the kidneys, as gallic acid. 

Therapeutics. — Gallic acid may be used with much success in hcemat- 
uria, haemoptysis, colliquative sweats, and in bronchorrhoea with profuse 
expectoration. 

Combined with opium it is one of the best remedies in diabetes 
lus, and is even useful in diabetes mellitus. 

In albuminuria dependent upon a relaxed, atonic state of the kidneys 
and in night-sweats and acute or chronic diarrhoea, gallic acid may be 
used with advantage. In the form of the ointment it is useful in the 
treatment of psoriasis, and in the cure of ulcers and sores which are 
actively discharging. 

Administration. — Gallic acid is given in the dose of 2 to 40 grains 
in pill or solution. It ought never to be used with any salt of iron, 
as it is incompatible. The official preparations are Unguentum Acidi 
Gallici, U. S., used locally, and Glycerinum Acidi Gallici, B. P., given 
in the close of 10 to 60 minims. 

Nut-gall. 

Nut-galls (Gf-alla, U. S. and B. P.) are the small excrescences found 
upon the oak (Quercus Infectoria) formed by the ova of the fly Cynips 
Gallce Tinctorice. Their sole value depends upon the tannic acid 
contained in them, and they are official in the form of the tincture 
(Tinctura Gallce, TJ. S. and B. P.), dose J to 2 fluidrachms ; and the 
ointment ( Unguentum Gallce, TJ. 8. and B. P.). Unguentum Gallce 
cum Opio is official in the B. P., and is used as an astringent and 
sedative ointment. 



182 DRUGS, 



GAULTHERIA. 



Wintergreen, or Gaultheria Procumbens, is an American evergreen 
containing a volatile oil. The oil possesses a peculiar, exceedingly 
penetrating odor aud a warm aromatic taste. It is about 90 per cent, 
salicylate of methyl. 

Physiological Action. — Owing to the large amount of salicylate of 
methyl contained in the oil, its physiological action is almost identical 
with that of salicylic acid. (Wood and Hare.) 

Therapeutics. — Aside from its use as a flavoring substance, oil of 
gaultheria is largely used in all forms of rheumatism, and in place of 
the ordinary salicylates. It does not so commonly disturb the diges- 
tion of patients as do the salts of salicylic acid or the acid itself. The 
oil {Oleum G-aultherice, U. S.) is best given in capsules or emulsion, 
or dropped on a teaspoonful of sugar, three times a day after meals. 
The dose may be as high as 100 drops a day ; if 60 drops three times 
a day do no good, pushing it further is practically useless. 

The spirit of gaultheria (Spiritus G-aultherice, U. S.) is given in 
the dose of 10 to 20 minims. 



GELSEMIUM. 

Gelsemium, U. 8. and B. P., or yellow jasmine, as used in medicine, 
is the rhizome of the Gelsemium Sempervirens, a climbiug plant of 
the southern United States. It contains an alkaloid, gelsemine, and 
gelseminic acid. 

Physiological Action. Nervous System. — Gelsemium paralyzes 
the spinal cord, particularly on its sensory side (?), although the motor 
side is certainly ultimately depressed. It does not influence the 
nerves or muscles except those of the head, on which it acts as a 
paralyzant particularly affecting the motor fibres. 

Circulation. — Gelsemium is a depressant to the circulation, acting 
particularly on the heart. 

Respiration. — Gelsemium kills by paralyzing the respiratory cen- 
tres. (Sanderson, Ringer, and Murrell.) 

Temperature. — In overdose the drug lowers bodily heat very 
markedly. 

Eye. — Gelsemium is a mydriatic of considerable power, causing, 
when dropped into the eye, wide dilatation of the pupil, a result due 
to paralysis of the oculo- motor nerve. 

Therapeutics. — Gelsemium is used in headache and migraine de- 
pending on nervous troubles or upon eye-strain. It is particularly 
useful in combination with cannabis indica. (See Cannabis Indica 
aud Migraine ) 

In malarial fever it is said to be of great service, but this is doubt- 
ful. In the early stages of pneumonia and pleurisy it has been highly 
spoken of by Bartholow. 



GENTIAN. 183 

Gelsemium lias also been found of value in asthma, whooping-cough, 
laryngismus stridulus, and nervous cough. In localized muscular spasm, 
such as is seen in torticollis or wry-neck, and in spasmodic dysmenorrhea, 
it is of considerable service. It ought not to be used if the system 
is already depressed, but only in sthenic cases. 

When used as a mydriatic Tweedy recommends it as equal to atro- 
pine in effect, but much more transient in its influence. He uses a 
solution of 8 grains of gelsemine to the ounce of water, instilled, drop 
by drop, into the eye every fifteen minutes for one hour, and then 
every half-hour for two hours. 

Poisoning. — The most prominent symptoms of gelsemium poisoning 
are ptosis and dropping of the jaw. These are preceded by a sensa- 
tion of languor, a desire to lie down, relaxation and muscular weak- 
ness. Gelsemium is apt to cause temporary internal squint owing to 
its paralyzant action on the sixth pair of cranial nerves. The pulse 
becomes rapid and feeble, the skin wet and cold, the face pinched and 
anxious, the voice is lost in aphonia, and death ensues from centric 
respiratory failure and an almost simultaneous cardiac arrest. Sensa- 
tion in man is impaired very late in the poisoning. 

The treatment of the poisoning consists in the use of cardiac stimu- 
lants, such as ammonia, digitalis, and atropine, the application of ex- 
ternal heat, and the employment of atropine and strychnine for the 
purpose of stimulating the respiratory centre. Emetics and the 
stomach-pump are, of course, to be employed. 

Administration. — The fluid extract, Extractum Gelsemii Fluidum, 
TJ. S.) is given in the dose of 5 to 10 minims, and the tincture ( Tine- 
tura Gelsemii, TJ, S. and B. P.) 10 to 20 drops. Gelsemine may be 
used in the dose of y=g- of a grain. Extractum Gelsemii Alcoholicum, 
B. P., is given in the dose of \ to J grain. 



GENTIAN. 

Gentiana, TJ. S., is the root of the Gentiana Lutea, or yellow gen- 
tian, a European plant. It contains gentianine and gentisic acid and 
has a bitter taste. This drug is official in the B. P. as Gentiance 
Radix. 

Therapeutics. — Gentian is one of the most efficacious bitter tonics 
that we possess, as well as one of the most elegant. In the anorexia 
following acute diseases and in gout and malarial poisoning with dys- 
pepsia it is of service. Combined with bicarbonate of sodium it is of 
great service in the treatment of the gastric and intestinal catarrh of 
children. 

Administration — The compound tincture (Tinctura Gentiance Com- 
posita, TJ. S. and B. P.) is given in the dose of a drachm to a wine- 
glassful, the fluid extract (Extractum Gentiance Fluidum, TJ. S.) in the 
dose of 30 drops to a drachm, and in the solid extract (Extractum 
Gentiance, TJ. S. and B. P.) in the dose of 1 to 8 grains. Infusum 
Gentiance Compositum, B. P., is given in the dose of 1 to 2 fluid- 



184 DRUGS. 

ounces, and the compound tincture {Tinctura Gentiance Oompositus) in 
the dose of J to 1 fluidrachm. The compound tincture and infusion 
are composed of gentian, bitter orange peel, and cardamoms. The fol- 
lowing prescription is an excellent one for use in convalescence from 
prolonged fevers : 

R. — Acid, nitro-hydrochlor. dil. . . f £j vel fgij. 

Tr. nucis vomicae f£j. 

Tr. cardamomi comp f^ij- 

Tr. gentianse comp. . . q. s. ad f^iv. M. 

S. — Teaspoonful in water after meals. 



GERANIUM. 

Geranium, U. 8., is the rhizome of Geranium Maculatum. It con- 
tains tannic and gallic acid and is useful in diarrhoea as an astringent. 
It is not the common red geranium seen in flower gardens. 

In infantile diarrhoea geranium root boiled in milk in the propor- 
tion of one or two roots to the pint will be found of great service, and 
is lacking in taste. The dose of the drug itself is 20 to 60 grains, 
and that of the fluid extract (Extr actum Geranii Fluidum, U. S.) J to 
1 fluidrachm. 

GINGER. 

Zingiber, U. 8. and B. P., is the rhizome of Zingiber Officinale, a 
plant of Hindoostan, Jamaica, and other tropical countries. Black 
ginger is the dried rhizome with its bark, while white ginger has this 
covering removed. It contains a hot volatile oil and an aromatic 
resin and is very largely used in domestic medicine as a carminative 
and stomachic. In the treatment of menstrual cramps it is often given, 
and is particularly useful in those due to suppression from exposure 
to cold. With purgative medicines ginger is employed for its flavor 
and the prevention of griping. Of itself it is decidedly constipating, 
and when used in diarrhoea mixtures is of value other than as a flavoring 
addition to the prescription. 

Administration. — The fluid extract (Extractum Zingiberis Fluidum, 
U. 8.) is given in the dose of 10 to 30 drops, well diluted. The tinc- 
ture (Tinctura Zingiberis, U. S. and B. P.), 20 drops to 2 drachms ; the 
syrup (Syrupus Zingiberis, U. 3. and B. P.), dose 30 drops to 2 drachms ; 
the oleroesin (Oleoresina Zingiberis, U. 8.), dose J to 1 drop, well 
diluted, or in pill, and the troches (Trochisci Zingiberis, U. 8.) used as 
stimulants to salivary secretion. In the B. P. a stronger tincture, 
Tinctura Zingiberis Fortior, is official, dose 5 to 20 minims. 



GLYCERIN. 

Glycerinum, U. 8. and B. P., is a liquid obtained by the decompo- 
sition and distillation of fats. It possesses ; great power of absorbing 



GLYCERIN. 185 

water and of dissolving many substances. Even if pure it irritates 
the skin of susceptible persous by its absorption of water, and often 
causes a slight rash. 

Physiological Action. — Injected into the circulation in large 
amounts, glycerin causes convulsions, which are due to its hydro- 
scopic power. 

According to the clinical researches of Pavy, glycerin increases the 
polyuria of diabetes almost one-half, aud for this reason he thinks 
it is not to be employed in this class of cases as a substitute for 
sugar. Again, the experiments of Luchsinger and Weiss have shown 
that the administration of this substance increases the amount of 
glycogen in the liver to a very considerable extent ; while, on the 
other hand, the researches of Eckhard and Luchsinger have also 
proved that glycerin very frequently tends to prevent glycosuria 
which has been brought about by puncture of the so-called diabetic 
centre in the floor of the fourth ventricle, if the drug be given hypo- 
dermically. Luchsinger, therefore, believed that while glycerin 
might increase the amount of glycogen, it also prevented its trans- 
formation into sugar by inhibiting the amylolytic action of the 
hepatic ferment. Eckhard believes that the hypodermic injection of 
glycerin produces such radical changes in the blood and general 
system that no conclusion can be made of the proper influence 
exerted by it. In a paper exceedingly useful and interesting, both 
from a physiological and clinical standpoint, Ransom, of London, has 
recently gone over this work in a satisfactory manner, and has tried, 
with considerable success, to unravel the somewhat complex pathology 
of the disease, as well as the equally complex and opposing statements 
of investigators as to the influence of glycerin. He points out that 
one element of fallacy in all these experiments is the fact that glycerin, 
when given hypodermically, must reach the liver so slowly and in 
such a diffused state as to be almost powerless, and, in consequence, 
Ransom introduced the glycerin into the alimentary canal. All the 
experiments seem to have been made in a most painstaking and 
careful manner, but as we have no space for their detail, we must 
pass them by in order to reach the results attained. These are as 
follows : 1. Certain forms of glycosuria may be checked by glycerin. 
2. Glycerin acts more efficiently when introduced into the alimentary 
canal than when injected subcutaneously. 8. Glycerin checks glycos- 
uria by inhibiting the formation of sugar in the liver. 4. By this 
means glycerin increases the quantity of glycogen found in the liver. 
While these conclusions are not final in proving the value of glycerin 
under such circumstances, it would seem probable that they are of great 
value in pointing toward a solution of one of the most complex subjects 
with which physicians are called upon to deal, and it is to be hoped 
that Ransom will publish other researches at a future time which 
will further elucidate this difficult subject. The quantity of glycerin 
which the writer would recommend to be given clinically by the mouth 
is 1 drachm diluted at least one-half with water. 

Therapeutics. — Glycerin may be employed as a sweetening agent in 



186 DRUGS. 

the food of diabetics and in cases where sugar cannot be used. It 
has also been given as a laxative, in 1 or 2 drachm doses by the 
mouth ; and in enema — 1 to 4 drachms with or without equal parts 
of water. In some cases it may be used in suppository. This latter 
method is very successful in chronic constipation. Its continued use 
by suppository may, however, result in rectal irritation. 

As an antiseptic it is used for preserving specimens, and for keeping 
alkaloids in solutions for hypodermic use. 

In acute coryza, applied by a spray or brush to the nostrils, it is 
sometimes of service ; for this purpose it should be diluted four or 
five times with water. If used on the skin it should be diluted one-half 
with water. In cases of impacted cerumen in the external auditory 
caual glycerin is often of service in softening the mass. 

The uses of glycerin, other than those mentioned, are many. In 
the proportion of 1 part of glycerin and 1 of water it makes a very 
useful mouth-wash in the sore and dry mouth of typhoid fever and for 
the removal of sordes. The same wash with lemon-juice added to it 
is very agreeable and will relieve the dry, glazed tongue of advanced 
phthisis. 

Owing to the fact that glycerin is hydroscopic, it may be used as a 
depletant on a pledget of cotton in congestion of the uterine cervix, the 
tampon being renewed daily. (See Boric Acid and Boroglyceride.) 

For the prevention of bed-sores Ringer recommends the daily 
washing and rubbing of the part likely to be affected, followed by the 
application of glycerin, and a draw-sheet placed smoothly against the 
patient to protect the bedding. 

Glycerin and whiskey is a favorite household remedy for colds and 
coughs, but is not very useful. Glycerite of starch (Glyceritum 
Amyli, U. 8. and B. P.) is used as a protective. Glycerite of yolk of 
egg (Glyceritum Vitelli, U. 8.) is used in making emulsions. 

A very useful ointment for the application of medicinal substances 
to the skin may be made by mixing constantly in the presence of heat 
1 part of potato starch and 15 parts of pure glycerin. The result is a 
clear, transparent, jelly-like substance which does not decompose and 
has the advantage of holding the medicament which it carries in solu- 
tion rather than by mechanical suspension. 

The B. P. preparations of glycerin are as follows : Glycerinum 
Acidi Carbolici ; Glycerinum Acidi Gallici ; Glycerinum Acidi Tan- 
nici ; Glycerinum Aluminis ; Glycerinum Boracis ; Glycerinum Plumbi 
Subacetatis, and Glycerinum Tragacanthw. 



GOLD. 

Gold is not official in the U. 8. Pharmacopoeia, but has been 
recommended very highly by Bartholow in chronic Bright 's disease in 
the form of the chloride of gold and sodium (Auvi et Sodii Chloridum, 
U. $.). The dose of this substance is -fa to ^ of a grain once, twice, 
or thrice a day. The author has not found it of much value. Gold 



GUAIAC. 187 

has also been strongly recommended for indigestion with epigastric 
pain after eating when looseness of the bowels is present, and is said 
to act as a powerful sexual stimulant aud to be of service in impotence 
dependent upon inability to obtain an erection or when there is de- 
ficient glandular action. In overdoses the drug causes gastro-enteritis. 
Magruder has recommended chloride of gold and sodium in the treat- 
ment of pertussis. 

GRINDELIA ROBUSTA. 

Grindelia, U. 8., is an American plant (Grindelia Robusta) con- 
taining a resin, a volatile oil, and an alkaloid. 

Physiological Action. — Upon the lower animals and man this drug 
is not very powerful in its action, but may cause, in large doses, 
paralysis of the peripheral sensory nerves, the sensory centres in the 
spinal cord, and finally the motor centres and nerve-trunks. It slows 
the heart by stimulating the vagi, and raises blood-pressure by stimu- 
lating the vasomotor centre. 

Therapeutics. — Grindelia robusta is an exceedingly useful remedy in 
some cases of asthma, and in bronchitis in its later stages. It may 
be given in the dose of 20 to 60 drops of the fluid extract (Extractum 
Grindelice Fluidum), or by inhaling the fumes of burning grindelia 
leaves which are previously soaked in a solution of nitre, dried, and 
burned on a plate, or rolled into a cigarette and smoked. In chronic 
cystitis it stimulates the bladder, and is of great service. By diluting 
it 1 to 10 with water it forms one of the best lotions that we have for 
the relief of the dermatitis produced by poison ivy or Rhus Toxico- 
dendron. 

Administration. — The only preparation which is official is the fluid 
extract (Extractum Grindelice Fluidum, U. 8.), dose 20 to 60 drops. 



GUAIAC. 

Lignum Vitse, or Guaiacum Officinale, a West Indian tree, is used 
in medicine in two forms — namely, as Guaiac wood (Guaiaci Lignum, 
U. 8. aud B. P.), which is in raspings and enters into the compound 
syrup of sarsaparilla, and Guaiac resin [Guaiac Resina, U. 8. and B. 
P.) or Guaiac, which is soluble in alcohol, ether, and chloroform, but 
insoluble in water. 

Therapeutics. — Guaiac has been largely used in syphilis, but is now 
rarely, if ever, so employed. Given in acute tonsillitis in the dose of 
30 grains in an emulsion made by the use of white of egg, it will often 
abort the disease. In rheumatism it has been largely used. The am- 
moniated tincture of guaiac is sometimes employed in the treatment of 
50 re-^roa^, particularly if it be rheumatic in type, but is a disagreeable 
preparation to take into the mouth. 

Aministration. — The tincture (Tinctura Guaiaci, U. 8.) is given in 
the dose of 5 to 60 drops, and the ammouiated tincture (Tinctura 



188 DRUGS. 

Gfuaiaci Ammoniata, U. S. and B. P.) is used in the same dose, prefer- 
ably in milk. Mistura G-uaiaci, B. P., is given in the dose of 1 to 
1J fluidounces. 

GUAIACOL. 

Guaiacol is a liquid constituting from 60 to 90 per cent, of creasote. 
It is obtained by the distillation of beechwood creasote, followed by a 
complicated process which it is not necessary to describe. In other 
cases guaiacol is obtained from beechwood creasote by precipitation 
with barium hydrate. Much of the " absolute guaiacol" of commerce 
is impure. Chemically pure guaiacol obtained by the process last 
named is a light-colored fluid of an agreeable odor and soluble in 
water in the proportion of 1 to 85 (Helbing). It is easily soluble in 
alcohol and ether. 

Therapeutics. — Guaiacol has been largely used by some practitioners, 
chiefly in Europe, for the treatment of tuberculosis, as a substitute for 
creasote, because it is the principal ingredient of that drug. (See 
Creasote.) It was thought by Guttmann, Sommerbrodt, and others 
that the good effect of creasote was due to its destructive action on 
the bacillus, or that it so improved digestion as to increase the resist- 
ance of the patient to the spread of the disease. Recently Hoelscher 
and Seifert have asserted that guaiacol and creasote produce their good 
effects by forming compounds with the toxines or poisonous albumin- 
oids formed by the bacilli, which are then eliminated from the body. 
The same rules govern the use of guaiacol as govern the employment 
of creasote. It is best given with brandy, wine, or other alcoholic 
drink, or in capsules with cod-liver or sweet oil. Five or ten drops 
of guaiacol may be added to a pitcher of hot water and the vapor 
inhaled 3 or 4 times a day in cases of subacute and chronic bronchitis. 
The dose by the stomach is 5 to 20 minims. 



GURJUN OIL. 

Gurjun Oil, or, as it is sometimes called, Gurjun Balsam, or Wood 
Oil, is the exudation obtained, by incision and the application of heat, 
from the bark of an East Indian tree. It is a transparent liquid pos- 
sessing the consistency of olive oil, of a greenish-gray color when held 
up to the light. It has an aromatic odor resembling to some extent 
that of copaiba. It is not, however, so disagreeable to the taste. 

Therapeutics. — Gurjun oil has been found of value in cases of chronic 
bronchitis where a stimulating expectorant of considerable power was 
desired, and this is particularly the case if the mucus in the bronchial 
tubes is very tenacious. The oil has also been found of value in 
gonorrhoea and gleet as a substitute for copaiba and cubebs. 

Administration. — Gurjun oil is best given in the dose of from 1 to 
2 drachms three times a day, combined with spirit of nitrous ether, 
mucilage of acacia and cinnamon water, or mixed with extract of malt 



HAMAMELIS. 189 

in the proportion of 2 drachms of the oil to an ounce of the extract. 
Persons having irritable stomachs may not be able to take this drug. 

HEMATOXYLIN. 

Hozmatoxylon, U. S., Hcematoxyli Lignum, B. P., or Log-wood, is 
the heart-wood of Hcematoxylon Campechianum, a tree of the Ameri- 
can tropics. It contains an alkaloid, hsematoxylin. 

Therapeutics. — Hsematoxylon is a mild astringent, very useful in 
serous diarrhoeas and in the diarrhoeas of young children, as children do 
not dislike it, owing to its agreeable taste. (See article on Diarrhoea.) 
As it colors the stools and urine red, the nurse should be warned, lest 
she be alarmed at the sight of what looks like blood on the diaper 
after the drug is given to infants. In leucorrhcea its internal use is 
of service. The extract (Extr actum Hcematoxyli, U. S. and B. P.) is 
given in the dose of 8 to 30 grains, and Decoctum Hcematoxyli, B. P., 
in the dose of 1 to 2 fluidounces. An unofficial fluid extract is often 
to be found in the shops. The dose of this is J to 2 fluidrachnis. 

HAMAMELIS. 

Hamamelis, U. S., Witch-hazel, or Hamamelis Virginica, is a plant 
of the United States, devoid of any true active principle, but possess- 
ing extraordinary remedial power. 

According to the studies of Wood and Marshall it has absolutely 
no physiological action, yet practically we know it to be a most useful 
remedy. 

Therapeutics. — Hamamelis is wonderfully successful in the treat- 
ment of uterine oozing from small bloodvessels, seems to do good even 
in hozmatemesis and haemoptysis, and will sometimes arrest hematuria 
when all other remedies fail. Applied by means of cloths to leg ulcers 
it acts very thoroughly and relieves the surrounding angry-looking 
skin at once. In bleeding from the bladder it may be injected into 
this viscus daily in the form of the distilled fluid extract. Taken 
internally and applied locally it is of value in the treatment of bleed- 
ing and the so-called blind piles. (See Haemorrhoids.) 

Injected into the part affected, or taken internally, hamamelis is of 
value in persons suffering from varicose veins. 

Administration. — The one official preparation is the fluid extract 
{Extractum Hamamelidis Fluidum, U. S.), dose 5 to 20 drops. The 
dose of the distilled extract, which is not official, and is a perfectly 
clear liquid, is from 30 drops to 1 drachm, and this is much the best 
preparation for internal and external use. Unfortunately, the prepa- 
rations of the drug vary very much both in odor and efficacy. Some 
of the proprietary preparations of witch-hazel are more active than 
those ordinarily dispensed in the drug store. This is due to greater 
care in their preparation and to the fact that they are sold in original 
packages without exposure to the air. 



190 DRUGS. 



HOFFMANN'S ANODYNE. 

Spiritus JEtheris Compositus, U. S. and B. P., consists of alcohol, 
ether, and the heavy oil of wine. The writer has experimentally 
studied very thoroughly the action of the last-named ingredient, and 
finds : 

First. That the belief in heavy oil of wine being the quieting ageut 
in Hoffmann's anodyne is fallacious. 

Second. The calmative effects of this mixture depend largely on the 
ether, rather than on the oil. 

Third. It would seem probable that iu Hoffmann's anodyne we 
possess an agent in which there are linked together three drugs of 
undoubted power, each one of which successively substitutes the other, 
stimulating the system in the order here named, viz., ether, alcohol, 
and the heavy oil of wine. 

On animal temperature, as ascertained by the thermometer in the 
rectum, the heavy oil of wine exercises no influence, even when the 
arterial pressure is very low. That large doses of the heavy oil of 
wine are in no way possessed of toxic effects is proved by the fact that 
30 c.c. of the drug given by the mouth to a small dog, weighing twelve 
pounds, failed to produce any apparent symptoms, except, perhaps, to 
stimulate him slightly. While the odor of the oil is penetrating it is 
by no means disagreeable, and it possesses but little taste other than 
that of the presence of an oily substance. 

Therapeutics. — Hoffmann's anodyne is the best carminative that we 
possess for general use, and is one of the best remedies for singultus 
or hiccough. These effects are accomplished probably in two ways : 
The alcohol and ether act as irritants or stimulants to the intestine, and 
free peristalsis results, while the heavy oil of wine acts, perhaps, as a 
nervous sedative. In angina pectoris this drug is often the best remedy 
we have, and in the cardiac palpitation of tobacco-heart or that arising 
from indigestion it is very useful. 

In the nausea and depression seen after excessive smoking, Hoff- 
mann's anodyne should always be given in capsules or in cold water, 
preferably ice-cold, in order to prevent too rapid volatization of the 
ether and consequent difficulty in swallowing the liquid. 

The dose is 1 to 2 drachms to an adult. 



HOMATROPINE. 

Homatropine is an artificial alkaloid obtained by prolonged and 
gentle heating of a solution of equivalent quantities of tropine 1 and 
toluic acid in hydrochloric acid. The hydrobromate of homatropine 
is a crystallizable salt of homatropine soluble in 10 parts of distilled 
water. 

1 Tropine is a product obtained by splitting up atropine into tropine and tropic acid.. 



HOPS. 191 

Hydrobromate of homatropine, properly applied by frequent instil- 
lations, is a reliable mydriatic for the correction of anomalies of refrac- 
tion in healthy eyes. Experience is not at hand to determine its value 
for this purpose in eyes affected with retino-choroidal disturbance. 
Atropine and hyoscyamine are preferred under such circumstances, 
for the obvious reason that their prolonged action is desirable as a 
method of treatment. The danger of systemic disturbance from homa- 
tropine is far removed, even when repeated instillations have been 
made, and its temporary action upon the pulse causes no inconvenience 
to the patient. Slight hyperemia of the conjunctiva almost invari- 
ably follows its use, but true conjunctivitis, if it occurs at all, must be 
excessively rare. According to the studies of Dr. de Schweinitz and 
the writer, the drug has a physiological action closely allied to that of 
atropine, from which it is derived. Homatropine mydriasis generally 
lasts from 36 to 48 hours, that of hyoscyamine 8 to 9 days, and that 
of atropine 10 to 12 days. For the production of ordinary mydriasis 
the drug should be used in solution of the strength of 4 grains to the 
ounce of distilled water, which is to be dropped into the eye every 5 
or 10 minutes. As the drug is expensive only a few drachms of the 
solution of the strength named should be ordered for a patient. 



HONEY. 

Honey, or Mel, U. S. and B. P., is the saccharine fluid deposited in 
combs by the honey bee, or Apis Mellifica. It is used to cover the 
taste of disagreeable medicines. When it is abstracted from a peculiar 
variety of flowers it frequently has the odor of the flower, and when 
taken internally may even produce the physiological effects of the 
plant from which it is gathered. This accident occurs commonly in 
those parts of the country where the bees have had access to mountain 
laurel and similar plants. 

Therapeutics. — Honey is used as an emollient in gargles and to 
relieve cough and dryness of the mouth and fauces. When used as a 
gargle it very distinctly increases the secretion of the mucous mem- 
brane, and so relieves the congestion. 

Under the name of Oxymel the B. P. recognizes a mixture of 8 parts 
of honey, 1 of acetic acid, and 1 of water. This is generally used as 
a vehicle for more active remedies in gargles, or even for expectorant 
mixtures. Melted and strained honey is known as Mel Despumatum, 
JJ. S., and Mel Depuratum, B. P. There are also a honey of roses 
(Mel Rosas, JJ. S.) and a confection (Confectio Rosas, JJ. S.) used as 
vehicles for other drugs. 

HOPS. 

Humulus, JJ. S., is the strobiles of ordinary hops, or Humulus 
Lupulus. They contain a liquid volatile alkaloid, lupuline, and a 
bitter principle, lupulinic acid. Hops are known under the name of 



192 DRUGS. 

Lupulus in the B. P. Much confusion has arisen in regard to the 
preparations of this drug partly because Humulus is the official name 
in the U. 8. P. and Lupulus in the B. P. This has been increased 
by the fact that the alkaloid of hops is called lupuline, while the 
powder which is found on the strobiles is called lupulin. Those 
preparations in the U. 8. P. having the word " humulus " in their 
name are made from the hops themselves. Those with " lupulin " 
in their name from the powder of the strobiles. 

Therapeutics. — Hops are used as antispasmodics and nervous seda- 
tives in cases of hysteria and nervousness. In priapism, vesical irri- 
tability, and renal irritation they are of service. Even in delirium 
tremens they seem to be of value. For local application a hop poul- 
tice may be made by placing the powdered strobiles in the mass, and 
employed in this way they are a favorite home remedy for local pain- 
ful inflammations. Hops have been used in the form of a hop pillow 
in nervous insomnia, but the soporific influence is largely imaginary, 
or depends on the fumes of the alcohol with which the pillow is 
moistened. 

Administration. — The tincture ( Tinctura Humuli, U. 8.) is given in 
the dose of J to 3 ounces. Lupulin (Lupulinum, U. 8. and B. P.), 
which is the powder found on the strobiles of hops, is given in the 
dose of 2 to 5 grains or more ; the oleoresin of lupuline ( Oleoresina 
Lupulini, U. 8.) is given in dose 10 to 40 drops in capsules, and the 
fluid extract (Extractum Lupulince Fluidum, U. S.), in the dose of 30 
to 120 drops. The preparations of the B. P. are the extract of 
hops (Extr actum Lupuli), dose 5 to 10 grains; the infusion (Infusum 
Lupuli), dose 1 to 2 fluidounces, and the tincture (Tinctura iMpuli), 



HOPE'S CAMPHOR MIXTURE. 

This is a mixture originally made with nitrous acid, but largely 
used at present with nitric acid, owing to the fact that nitrous acid 
is changed into nitric acid when water is added to it. The nitrous 
acid is, however, more efficacious than nitric acid in the serous or 
choleraic diarrhoeas which it is used to combat. The formula is as 
follows : 

R. — Acidi nitrosi f^j. 

Aquse camphorse f^viij. 

et adde 

Tinct. opii gtt. xl. 

S. — One-fourth of this in water every three or four hours. 



HYDRASTIS. 

Hydrastis, U. S., is the rhizome of the Hydrastis Canadensis, contain- 
ing two alkaloids, known as hydrastine and berberine, and, perhaps, 
xanthopuccin. 



HYDROCHLORIC ACID. 193 

Physiological Action. — In poisonous closes hydrastis may cause con- 
vulsions followed by paralysis, according to the quantity of berberine 
or hydrastine present. The latter is more convulsive in its effects 
than the former. Upon the circulation hydrastine, when injected into 
the jugular vein, causes a primary fall of arterial pressure succeeded 
by a decided rise, and the studies of Cerna have proved that it is an 
active poison producing spinal convulsions followed by paralysis. 

Therapeutics. — Hydrastis is of service in chronic g astro-intestinal 
catarrh, particularly that following the abuse of alcohol, and may be 
used as a stomachic and tonic after malarial fever and similar depress- 
ing diseases. Wherever membranes exist in a condition of lowered 
tone this drug is indicated. Thus, in catarrhal jaundice of a subacute 
type, in uterine catarrh, in leucorrhma dependent upon a relaxed state 
of the vagina, and in chronic nasal inflammations and irritations it will 
be found useful. 

Tincture of hydrastis is said to possess a distinct anti-malarial in- 
fluence. 

One of the best remedial measures that we have in the later stages 
of gonorrhoea, when the acute period has passed, is the local and in- 
ternal use of hydrastis. If it is used as an injection 5 grains of the 
commercial hydrastine to each ounce of water should be employed 
twice a day. If this is not used the following infusion will be found 
of service : Take 1 drachm of the powdered root and add it to 8 
ounces of boiling water. Half to one drachm of the fluid extract 
may also be added to a pint of water and used as a wash in vaginal 
gonorrhoea and leucorrhma. In chronic dyspepsia hydrastis seems to 
act as an antiseptic and as a curative agent upon the mucous mem- 
branes of the stomach. 

Administration. — The fluid extract (Extractum Hydrastis Fluidum, 
U. S.) may be given in the dose of 5 to 30 drops, while the dose of the 
tincture (Tinctura Hydrastis, U. S.) is from 30 drops to 2 drachms. 

Much doubt exists as to the dose of hydrastine. This arises from 
the fact that two forms of it are sold. That most commonly seen is 
a dark-brown mass which is very impure, and contains berberine and 
other substances. Its dose is 3 to 10 grains. The pure hydrastine, as 
made by Merck, is given in the dose of J to J grain. 



HYDROCHLORIC ACID. 

Acidum Hydrochloricum ( U. S. and B. P.) is a clear, colorless 
liquid, possessing an acid odor and taste, devoid of astri agency, but 
in concentrated form decidedly caustic. In the strength of two-tenths 
of 1 per cent, it is present normally in the gastric juice and aids the 
pepsin in the conversion of proteids into peptones, and in the formation 
of pepsin from pepsinogen. 

Therapeutics. — In dyspepsia due to faulty gastric secretion, as in 
tvphoid fever and in gastric indigestion, accompanied with fermenta- 
tion, this acid is of service. In combination with compound tincture 

13 



194 DRUGS. 

of cardamoms it is of value in intestinal indigestion. (See Indiges- 
tion.) The acid is best used in the form of the official dilute acid 
(Acidum Hydrochloricum Dilutum, U. S. and B. P.), dose 10 to 30 
drops in water. 

In the sick stomach and gastric distress following an alcoholic 
debauch, 20 drops of the dilute acid in water are often of service. 

This acid is combined with nitric acid to form dilute nitro-hydro- 
chloric acid (Acidum Nitro-hydrochloricum Dilutum, U. S. and B. P.), 
the dose of which is 10 to 30 minims ; also the pure acid {Acidum 
Nitro-hydrochloricum, TJ. S.), dose 1 to 5 minims. 

Hydrochloric acid causes, when taken in poisonous doses, violent 
gastro-enteritis and corrosion of the gastric walls, and its action should 
be combated by alkalies, soap, oils, and white of egg. 



HYDROCYANIC ACID. 

Hydrocyanic or Prussic Acid is a transparent, colorless, very vola- 
tile liquid, giving rise to vertigo when inhaled in minute amounts and 
producing death if the fumes be concentrated. If the bottle con- 
taining the pure drug be opened it should be done where there is 
sufficient draught between windows to prevent any contamination of 
the atmosphere of the room by the acid. 

Pure hydrocyanic acid is never used in medicine ; the form employed 
is that of the dilute acid (Acidum Hydrocyanicum Dilutum, U. S. 
and B. P.), which contains about 2 per cent, of the drug. It must be 
kept in dark, tightly-stoppered bottles. 

Physiological Action. — This is one of the most rapid, if not the 
most rapid, lethal poison known, only being approached by carbolic 
acid and nitrobenzole in the violence of its effects. Owing to its 
volatility it is absorbed with great rapidity, and acts upon the respir- 
atory centre and the heart, being eliminated almost immediately after- 
ward. As a consequence, the survival of a patient twenty or thirty 
minutes after the ingestion of a poisonous dose is a favorable sign. 

The drug is an active paralyzant and exerts a lethal influence over 
every part of the body. The nervous system, heart, respiration, 
brain, and all parts are killed at once if much of it is present. 

Poisoning. — Death either comes at once, so that the person drops dead 
to the floor with a gasp, is for a moment convulsed, the face cyanotic, 
the eyes wide open, with the teeth tightly shut, and the lips covered 
by a bloody froth, or, three stages of poisoning may ensue if the dose 
has not been very large. In the first of these there is difficult respi- 
ration, slow cardiac action, and disturbed cerebration. In the second 
stage, which is convulsive, we find wild cries, dilated pupils, uncon- 
sciousness, vomiting, spasmodic urination and defecation, erections of 
the penis and ejaculations of semen. In the third stage there is 
asphyxia, collapse and paralysis, ending in death. The blood is 
found to be dark and venous-looking, but does not give the spectrum 



HYDROCYANIC ACID. 195 

bands of cyano-hsernoglobin. These bands only appear when the 
drug is shaken with the blood outside the body. 

The diagnostic signs of death from prussic acid are the odor on 
the body, the wide-staring eye, the clinched teeth covered with froth, 
and the livid, cyauosed face. If the body be opened the odor of 
hydrocyanic acid is marked, but rapidly passes away. 

The only poisoning producing symptoms resembling those which 
have just been described is that produced by nitrobenzole or essence 
of mirbane, which has a somewhat similar odor, but which is, how- 
ever, more permanent, the odor remaining in the opened body for 
hours. 

Therapeutics. — Hydrocyanic acid is useful in cases of gastralgia 
of purely nervous origin, and in some cases of nervous vomiting, and 
in irritable stomach where, owing to a hypersesthesia of the mucous 
membranes, the taking of food produces discomfort. 

In irritable coughs, due to tickling in the throat and bronchi, it is 
very extensively used and has received high praise by those best 
qualified to judge. On the other hand, it has been claimed that 
owing to the extreme volatility of the drug it only acts for the mo- 
ment, and that a dose every ten or fifteen minutes is necessary to 
produce any real effect. However this may be in theory, practically 
the acid certainly does relieve cough. In these states the following 
prescription will be found of service : 

Be-- — Acid, hydrocyan. dil f^j. 

Morphinse sulph gr. ij. 

Syrup, pruni virg. f ^ iij. M. 

S. — Teaspoonful every four or five hours to an adult. 

In enter algid or neuralgia of the intestines, prussic acid is very 
useful. 

Externally the drug is useful in pruritus and other forms of itching 
shin diseases, aud the following formula will be found of service in 
pruritus vulval : 

R . — Hydrarg. chlor. corros. . . . gr. J. 

Acid, hydrocyanic, dil.. . . . . f sjj. 

Aquae amygdal. amarse . . . . fjvj. M. 

S. — Apply to the itching surface with a small rag. 

The same prescription may also be employed in pruritus without 
the bichloride, if so desired. The dose of dilute hydrocyanic acid is 
1 to 5 drops. In certain forms of irritable cough inhalations of the 
vapor ( Vapor Acidi Hydrocyanici, B. P.) are recommended ; it is 
prepared by adding 10 to 15 minims of the diluted acid to 1 fluid- 
drachm of water, which is then placed in a suitable apparatus from 
which is inhaled the vapor that arises. 



196 DKUGS. 



HYDROGEN PEROXIDE. 

(See Oxygen.) 

HYOSOYAMUS. 

Hyoscyamus, U. 8., or Henbane, is a plant of the northern United 
States and Europe. The leaves (Hyoscyami Folia, B. P.) only are 
used, and from them are obtained two alkaloids, one known as hyos- 
cyamine, the other as hyoscine. The first has the same physiological 
action as atropine (see Belladonna). The second is quite different in 
its influence over the body. The only marked difference in the action 
of hyoscyamine and atropine is in the mydriasis produced by each. 
While that of atropine lasts, in man, from twelve to fourteen days, 
hyoscyamine generally remains for only seven to nine days. Owing 
to the presence of hyoscine in hyoscyamus it is more quieting and 
depressing to the nervous system than is belladonna. 

Therapeutics. — Hyoscyamus is used in every condition indicating 
the employment of belladonna ; or, in other words, wherever local 
spasm, or arterial relaxation exists or where pain is due to spasm. 
It has been particularly recommended in nervous cough, in whooping- 
cough, and in colic, and probably is better in its influences in these 
states than is belladonna. In combination with nitrate of silver the 
extract may be used with advantage in chronic gastric catarrh. In 
urinary incontinence due to irritable bladder it is very serviceable, and 
particularly is this true of this affection in children and old persons. 

Administration. — The drug itself is official in four forms, and as 
hyoscyamine sulphate. The dose of the tincture (Tinctura Hyos- 
cyami, U. 8. and B. P.) is 30 drops to 1 drachm ; the alcoholic ex- 
tract (Extractum Hyoscyami Alcoholicum, U. S.), dose 1 to 3 grains; 
the alkaloid (Hyoscyaminw Sulphas, U. 8.), dose -g 1 -^ to -^ of a grain ; 
the abstract (Abstractum Hyoscyami, U. 8.), dose 2 to 3 grains ; and 
the fluid extract (Extractum Hyoscyami Fluidum, XI. S.), dose 5 to 30 
drops. The B. P. preparations besides those given are the extract 
{Extractum Hyoscyami), dose 2 to 5 grains, or more, and the juice 
(8uccus Hyoscyami), dose 30 minims to 1 fluidrachm. 

Hyoscine. 

This is one of the alkaloids derived from hyoscyamus and is a 
powerful nervous depressant. 

Physiological Action. — Hyoscine quiets the cerebrum and produces 
deep sleep in a certain class of patients. In the lower animals, or in 
man, it may cause sleep or wild delirium. It causes loss of reflex 
action in overdose, which is due to paralysis of the spinal cord and 
not of the nerve-trunks. Upon the circulation it has little effect, but 
it is worthy of note that it does influence the vagus nerves, as does 



HYPNAL. 197 

atropine, stimulating them at first, and finally paralyzing them; 
although the contrary has been asserted. In any event the circulatory 
effect is a minor one. 

Therapeutics. — Hyoscine is of value as a hypnotic in a very limited 
class of cases, but in this class generally acts most favorably. These 
cases consist of those who, from acute mania, alcoholic mania, 
hysteria, or similar cause, suffer from insomnia, and perhaps use 
violent struggles against proper control or refuse to swallow or retain 
food. 

The drug may be given to such persons hypodermically, in the 
dose of yJ-q- to -?fQ of a grain, or by the mouth in the dose of -^ to 
§V of a graiu. The fact that it possesses no taste, and is small in 
bulk, renders it ready of employment. In some persons it utterly fails, 
even in this particular type of cases. 1 In delirium tremeus it may 
cause evidences of cerebral congestion and Cheyne-Stokes breathing. 
Some cases are not quieted by the drug, but pace up and down in a 
semi-sane condition until its action wears off. In the opinion of the 
writer the applicability of the drug is very limited indeed, and un- 
toward effects are common. 

Hyoscine is said to be of great value in spermatorrhoea and nocturnal 
emissions. 

The drug is contra-indicated in the sore-throat of scarlet fever, as 
it may cause glottic spasm. In the insomnia of heart disease with 
nervousness it will cause sleep, but may also produce death by respi- 
ratory failure or cardiac arrest, and it is to be remembered that the 
drug will produce asthma rather than relieve it. The breathing, in 
some persons, may become under its influence croupy or rasping. 

Hyoscine is an uncertain remedy in nervous affections, sometimes 
acting very well, at others producing very alarming symptoms in 
cerebration, circulation, and respiration. 



HYPNAL. 

The chemical name of this substance is monochloralantipyrine, or 
monotrichloracetyledimethylphenylpyrazalon, and it is, as its name 
indicates, a compound of chloral and antipyrine. There is also a 
dichloralantipyrine, which contains more chloral. The compound 
is employed in treating those patients who suffer from pain and in- 
somnia combined, the antipyrine relieving the pain and the chloral 
producing sleep. Opium is the only drug known which can be relied 
upon to act in this double manner, and the disadvantages of that 
medicament are often so prominent as to prevent its use. In cough 
arising from bronchitis or phthisis, and causing by its constancy loss 
of sleep, and in neuralgic insomnia, hypnal will be found of service. 

1 The writer has given one-tenth of a grain of Merck's hyoscine in twenty-four 
hours, obtained from two different and reliable stores, without producing sleep, 
although the respirations were much quickened. 



198 DRUGS. 

The dose is from 5 to 20 grains, best given with simple syrup and 
water or with syrup of orange peel, or it may be used as follows : 

Hypnal gr. xv. 

Chartreuse f zj. 

Distilled water f j§ ss. M. 

S. — The entire amount to be taken in one dose. 



IOHTHYOL. 

Ichthyol is a substance obtained by distillation from a peculiar 
resinous accumulation found chiefly in the Tyrol, and supposed to be 
the result of a deposit of extinct fish. Ichthyol occurs as the ichthyo- 
sulphate of sodium or ammonium. Both of these contain about 10 
per cent, of sulphur, aud it is largely upon this that their therapeutic 
activity depends. The disagreeable odor of ichthyol depends upon 
the presence of an inseparable volatile oil. 

Therapeutics. — Ichthyol is without doubt one of the most remark- 
able substances used for medicinal purposes which has appeared in the 
last decade. In skin diseases it has been most highly recommended 
on both sides of the Atlantic, and is employed in the form of ichthyol 
ointment in chronic eczema, acne, urticaria, and even on lupus and 
keloids. In almost all chronic skin affections it is of the greatest 
value, and the writer has seen it exert a most favorable influence upon 
erysipelas both in hospitals and in his private practice. Under these 
circumstances the ointment should contain about 20 per cent, of 
ichthyol, or less. Some practitioners recommend that ichthyol be 
applied in a watery solution of the strength of 1 drachm to the 
ounce, by means of a camel's-hair brush. Under these circumstances 
it is necessary to wash the parts with oil and water every day, 
using the greatest gentleness. It has also been fouud by the writer 
very efficacious in the pain and swelling accompanying acute rheuma- 
tism of the joints, both during and after the acute stage of the disease. 
The strength for this use should be about 30 parts of ichthyol to 
70 of benzoinated lard. In frost-bites, chilblains, and in burns it is of 
service, and Agnew has recommended it highly when rubbed into 
lymphatic enlargements. Ichthyol has proved remarkably efficacious 
in removing peri-uterine and other pelvic exudations when used as a 
salve or in a vaginal suppository. 

For acute sprains, and for the removal of the swelling following 
such injuries, its influence is extraordinary if it be well rubbed into 
the part affected. 

Owing to the disagreeable odor of ichthyol, oil of citronella ought 
to be added to it, as follows : 

R.— Ichthyol gij. 

01. citronellse .... gtt. xv vel. xxx. 
Adepis . 3j. M. 

The dose of ichthyol internally is 1 to 10 minims, given in pill. 
When used in this way the sodium salt should be used. 



IODIDE OF POTASSIUM. 199 



IGNATIA. 

Ignatia, U. S., or Ignatia bean, is the seed of the Strychnos 
Ignatia. It contains two alkaloids, strychnine and brueine, as does 
nux vomica. 

Physiological Action. — Its physiological action is identical with 
that of strychnine or nux vomica. 

Therapeutics. — (See Nux Vomica.) The abstract of ignatia (Ab- 
straction Ignatice, U. S.) is given in the dose of 1 grain ; the tincture 
(Tinctura Ignatice, U. S.) in the dose of 10 to 15 minims. 



IODIDE OF AMMONIUM. 

Ammonii Iodidum, U. S., is used in smaller doses, but for the same 
purposes as the iodide of potassium. It is preferred by some practi- 
tioners to the latter salt when the respiratory or digestive tracts are 
involved, but is much more irritant. The dose is from 2 to 10 
grains. 

IODIDE OF ETHYL. 
(See Ethyl Iodide.) 

IODIDE OF POTASSIUM. 

The physiological effects of iodide of potassium (Potassii Iodidum, 
U. S. and B. P.) are entirely comparable to those of iodine itself, but 
it is employed for somewhat different purposes, is less irritant, more 
readily given, and perhaps more readily absorbed. 

Physiological Action. Circulation. — Upon this part of the 
system iodide of potassium produces effects differing very slightly, if 
at all, from those caused by potassium itself. Small amounts raise the 
blood-pressure, and large quantities lower it. (Prevost and Binet.) 

Elimination. — Iodide of potassium is very rapidly eliminated, 
appearing, according to Doux, in thirteen minutes after it is ingested 
in the urine, and the daily amount excreted equals about 90 per cent, 
of the dose taken. All traces of the iodide in the urine cease 4 or 5 
days after the last dose is administered. (Ehlers.) 

Therapeutics. — The use of iodide of potassium may be divided into 
three great divisions, each of which is important. It is also employed 
for many conditions not included in these classes. 

1. Syphilis. — The use of iodide of potassium in syphilis is recog- 
nized as a part of all treatment for its relief. Elsewhere Dr. Martin 
has, in his excellent article (see Syphilis), treated of this question, and 
it is only necessary to call attention to the fact that the drug is generally 
well borne in large amounts by advanced syphilitics, although this is 



200 DRUGS. 

not always the case. The term u therapeutic test" is applied by one 
eminent teacher to signify a state of the system produced by syphilis 
in which a diagnosis may be made by the fact that large doses of the 
iodide "are borne without inconvenience. As already intimated, this 
resistance does not always prove the presence of syphilis, nor does 
its absence prove the absence of this disease. Persons having heredi- 
tary asthma, gout, rheumatism, or some similar diathetic malady, often 
resist the iodide, and some syphilitics are affected with " iodism " after 
very small doses. In treating syphilis the drug should be used in the 
dose of 10 grains three times a day, and this amount gradually in- 
creased a grain a day until symptoms of i( iodism " occur. 

The quantity borne often amounts to from 100 to 200 grains a day. 
The best way to use the iodide of potassium is to order for the patient 
a saturated solution of the drug, which contains in each drop about 1 
grain, and at the same time a bottle of the compound syrup of sarsa- 
parilla. To a tablespoonful of the latter the patient is to add the 
iodide solution, beginning with 10 drops three times a day and in- 
creasing a drop every twenty-four hours. 

The iodide acts more slowly as an anti-syphilitic than does mercury. 

In tertiary syphilis the iodide is invaluble. 

In nervous syphilis, be its manifestations what they may, iodide of 
potassium is the standard remedy, only being supplanted by mercury 
when it is necessary to break down a growth whose existence is a daily 
menance to the patient's life. 

2. Metallic Poisoning. — Owing to the fact that iodide of potas- 
sium forms double soluble salts with all the metals in the tissues in 
chronic poisoning, thereby aiding in their elimination, it should always 
be employed in chronic lead, zinc, arsenic, or mercurial poisoning. 

3. Anti-rheumatic. — Iodide of potassium is best suited, not to 
the acute sthenic stages of rheumatism when the joints are very hot 
and painful, but to the secondary or subacute periods when the joints 
are large and the case " hangs on " — now better, now worse. It acts 
best, under these circumstances, if combined with wine of colchicum- 
root (see Rheumatism). It is also to be tried in sciatica, lumbago, and 
rheumatic neuralgia, and should be employed in chronic pleurisy, peri- 
carditis, and hydrocephalus, to cause absorption of the fluids. 

In aneurism, particularly that of the aorta, the drug does good, 
but its value rests largely upon the cause of the disease. If it is due 
to syphilis the aneurism yields very rapidly to the drug. The pain, 
swelling, and pulsation generally decrease. 

In asthma iodide of potassium is valuable if the disease is of the 
bronchial type, but it ought not to be employed if it is gastric. In 
bronchitis and intestinal catarrh where the condition of the mucous 
membranes is semi-chronic, and not relieved by chloride of ammo- 
nium, iodide of potassium should be used. If the bronchitis is chronic 
and the secretion profuse (bronchorrhcea) iodide of potassium will 
make it worse. The dose for an adult in all these instances should be 
about 3 to 5 grains three times a day. In pulmonary emphysema 
iodide of potassium is often of great value. 



IODIDE OF POTASSIUM. 201 

In chronic nephritis small doses (5 grains t. d.) are thought by some 
to check the disease, but it is to be remembered that the drug may 
produce poisouing if the kidneys do not eliminate it, so that, if used 
at all, it must be with great care. If the drug is well borue it will 
cause an extraordinary increase in the urinary flow, and will relieve 
any dropsy which may be present very rapidly indeed. 

In bronchocele the employment of iodide of potassium internally, 
and tincture of iodine externally, is the best treatment we can use, and 
in acute coryza, or " cold in the head," 10 grains of the iodide taken 
at the beginning of the trouble will often abort the attack. 

In hepatic cirrhosis, in its early stages, the iodide often does good, 
and in arteriosclerosis, or atheroma of the bloodvessels, it is of great 
service, according to many English, French, and American writers. 

A very important use of iodide of potassium is for the removal of 
enlargements of the cervical glands and those occurring in other parts of 
the body. In enlargements of the spleen, malarial or otherwise, exter- 
nal paintings with iodine and the internal use of the iodide in small 
doses are of service. In the later stages of 'pneumonia the iodides 
are useful to aid in the absorption of any exudates, but they are 
contra-indicated in phthisis, except in the fibroid form and in many 
of these cases when dependent upon syphilis, as they aid in the break- 
ing down of the lung. 

Untoward Effects. — In some persons, after the use of the iodide, 
coryza with a tearful condition of the eyes comes on, so that the edges 
of the lids become reddened and the nose runs constantly. This is 
followed, if the drug is pushed, by the more positive signs of "iodisni" 
spoken of under Iodine. 

In other cases acne breaks out on the face and disorders of digestion 
and gastric irritability come on. The acne can nearly always be pre- 
vented by giving arsenic at the same time with the iodide. In some 
cases petechial rashes break out on the legs, while in others great 
mental and physical depression appear, so that listlessness or melan- 
cholia may develop. 

In persons susceptible to iodide of potassium care should be exer- 
cised when it is first administered lest sudden and dangerous oedema of 
the glottis occur. 

Sometimes the iodide of ammonium or iodide of sodium will be 
borne when the iodide of potassium will not. 

If bulla? or blebs follow the use of the iodides, or other rashes 
appear, it is said that atropine will afford relief. 

Administration. — The iodide of potassium, owing to its exceedingly 
disagreeable taste, should be given with the compound syrup of sarsa- 
parilla, extract of liquorice, or in milk. Large amounts of these vehicles 
are to be used. The dose varies from 5 to 60 grains, according to the 
condition of the patient. 

One of the best ways to take the drug is in capsule, but if this is 
done a drink of milk or water or other fluid should precede or follow 
it, in order to prevent the drug from coming in contact with the 
stomach in concentrated form. The preparations of the iodide of 



202 DRUGS. 

potassium are : Unguentum Potassii Iodidi, U. S. and B. P., and the 
linimeut (Linimentum Potassii Iodidi cum Sapone, B. P.). 



IODIDE OF SODIUM. 

Sodii Iodidum, U. 8. and B. P., is used in the same doses and .for 
the same purposes as the iodide of potassium. 



IODINE. 

Iodum, U. 8. and B. P., is a non-metallic element found largely in 
seaweed and in mineral iodates and iodides. It is soluble in ether 
and alcohol, but slightly so in water, and possesses an acrid burning 
taste and a neutral reaction. 

Physiological Action. — The physiological action of iodine, so far as 
its alterative powers are concerned, is absolutely unknown. Applied 
to the skin it stains it yellow, brown, or black, according to the free- 
dom of its application, and it acts without pain if the skin is intact. 
If very large amounts are used it produces vesication. Upon mucous 
membranes iodine acts as a powerful irritant. Germain-See believes 
it to be a stimulant to the nutritive processes of the body and to the 
circulatory system, and he is certainly correct in regard to the influ- 
ence it exercises over nutrition. 

Elimination. — The drug escapes chiefly through the kidneys, the 
skin, the salivary glands, and it even appears in the milk of nursing 
women. 

Poisoning. — The symptoms of acute poisoning by iodine are those 
of acute gastro-enteritis Avith severe pain in the oesophagus, stomach, 
and abdomen, accompanied by violent vomiting and purging. An 
early symptom is the persistent strong metallic taste in the mouth, 
with markedly increased salivation. The pulse becomes rapid, run- 
ning and feeble, the face deathly pale, total arrest of urinary secretion 
takes place through renal irritation, and death occurs by failure of 
respiration, which is accompanied by loss of all vital power. 

If the poisoning is not severe enough to cause death at once, a 
fatal result is, nevertheless, often reached after a few days, by reason 
of a widespread fatty degeneration of the tissues. 

The treatment of the poisoning consists in the use of large amounts 
of starch in any of its forms as the antidote, the employment of 
emetics and the stomach-pump, the application of heat to the body 
and extremities, and, finally, the employment of hypodermic injections 
of alcohol, digitalis, ammonia, and atropine or strychnine, for the pur- 
pose of maintaining the strength of the circulatory and respiratory 
system. 

Chronic Poisoning. — Under the name of " iodism " the profession 
recognizes a state of the body brought on by the prolonged and ex- 
cessive use of iodine in any of its forms. The earliest signs of this 



IODINE. 203 

state are shown by a peculiar metallic taste in the mouth, particularly 
before breakfast, slight tenderness of the teeth and gums, increase of 
salivary secretion, a little morning nausea and lack of appetite for 
breakfast, and perhaps some coryza or evidence of gastric irritation. 
Acne rosacea often comes on very early. If the drug is continued 
all these symptoms become more marked and the coryza becomes in- 
tense. Headache under the frontal bone and sore-throat often appear, 
and the pustular and bleb-like changes in the skin go on to active 
suppuration. Sometimes large boils appear, or purpura hemorrhagica 
comes on. 

In other cases the nervous system chiefly suffers. Twitchings of 
muscles, neuralgic pains in the trunk and extremities, and wasting 
of the testicles, mammae, and all other tissues occur, as the result of 
trophic disturbances. Anaemia amounting to an actual cachexia is 
commonly produced. Loss of vision and paralysis may ensue in ex- 
treme cases. 

Therapeutics. — In all cases where the system is in a state of chronic 
perverted functional activity, as in those diseases associated with 
disorder of the processes of nutrition and often included under the 
single name of scrofulosis, iodine is of service. In enlargement of the 
lymph-glands it is, in its various forms, one of the best remedies we 
possess, but it ought not to be employed in those cases where rapid 
changes are going on in the gland, such as the formation of pus, since 
under these circumstances it will increase the size of the slough. 
The drug ought never to be used in phthisis because it tends to disin- 
tegrate the tissues, and this is precisely what the disease is doing. In 
the exceedingly chronic form of pulmonary disease known as fibroid 
phthisis iodine may be used. When inhaled in fumes it may be of 
service as a stimulant to the mucous membranes, but is never of value 
in phthisis otherwise. In countries where exophthalmic goitre is 
very prevalent iodine ranks as a most efficient remedy. In cystic 
enlargement of the thyroid gland it is valueless, but in simple hyper- 
trophy of the gland is of great value. 

In chronic bone disease iodine applied about the affected joint in the 
form of the ointment diluted one-half with lard, or in the pure tinc- 
ture, will be found of service, and if anosmia exists the syrup of the 
iodide of iron should be given internally. 

The other uses of iodine externally are many and important. As 
a slow counter-irritant which does not produce pain if properly em- 
ployed, it is particularly useful in children, and may be employed in 
one to three coats, aud no more. 

The proper way of using the tincture is to give one good black coat 
at one sitting, and not to repeat it until the skin has desquamated and 
become well renewed. If iodine is applied soon after one good effec- 
tive coat it will cause agonizing burning pain, which nothing will 
relieve except the removal of the iodine by the use of cologne-water, 
alcohol, whiskey, or gin. The application of any of the latter liquids 
causes such an increase in the pain as to be almost useless after the 
skin is broken. The best solution for its removal is one of iodide of 



204 DRUGS. 

potassium, which should be followed by a poultice. A good rule to 
follow is never to cause pain by the use of iodine, as the drug acts 
equally well if applied in such a way as to avoid suffering. 

Iodine in the form of the tincture is applied as a counter-irritant 
paint in pleurisy, both to abort an attack and to aid in absorption of 
the fluid after it is thrown out into the chest. In harassing irritative 
cough it may be painted over the supra-clavicular spaces, and it will 
lessen the secretion in chronic bronchitis if used in this way. In 
chronic rheumatism affecting the joints and muscles it does good when 
locally applied. Often in synovitis the local application of iodine 
causes increased swelling for some days. This should not cause 
alarm, for ultimately the swelling decreases very greatly, and the cases 
in which this occurs are generally the best from a prognostic point of 
view. 

In the course of phthisis every now and then a " spot " in the chest 
will become " sore," probably due to a limited area of pleurisy, and, 
under these circumstances, tincture of iodine locally applied will give 
relief. In lupus the tincture may be painted around the edges of the 
growth, and even over its surface, with the object of retarding its 
spread. In chilblains an application of iodine ointment gives the 
greatest relief if diluted one-half with lard, and its use is probably 
the most efficacious measure at our disposal. In certain individuals 
who have " pains in the chest" iodine ointment may do good if applied 
over the spot. As has been pointed out by others, iodine does good if 
muscular tenderness is present, while it fails if pleurodynia or inter- 
costal neuralgia is the cause of the suffering. The latter troubles 
should be removed by the use of belladonna. In certain forms of skin 
diseases, such as tinea tonsurans and circinata, tincture of iodine may 
be applied with a camel's-hair brush, and even the entire scalp may be 
painted. A better way is to apply it to different spots each day. 
When erysipelas is present the tincture may be painted around the 
edges of the inflammation, in order to prevent its spread. 

In old persons, or those in middle life, retraction of the gums from 
the teeth sometimes comes on, and Stille recommends for this disorder 
the use, by means of a camel's-hair brush, of a watery solution of 
iodine of the strength of 1 grain to the ounce, to be followed at once 
by a thorough rinsing of the mouth with pure water. In hydrocele 
iodine in the form of the tincture is the best remedy for effecting a 
permanent cure that we have. The sac should first be emptied by the 
use of a trocar and canula, and the iodine alone, or with glycerin, in- 
jected with a syringe, and then allowed to escape. As the pain is most 
atrocious, the patient should first be put partly or entirely under the 
influence of ether or other anaesthetic. 

In white swellings and ovarian tumors as much as 10 ounces of the 
tincture may be injected, but it is to be remembered that certain dan- 
gerous symptoms may arise. After its use in this way in the chest 
violent symptoms of poisoning have come on, in some cases the most 
common complication being convulsions. These are epileptiform in 
character and are followed by coma or collapse. 



IODINE. 205 

In empyema a solution of iodine 6 grains, iodide of potassium 6 
grains, and water 1 pint, may be used daily as an irrigating fluid with 
good results. 

The tincture of iodine may be used, according to Ringer, as an 
inhalation with signal benefit in the following four instances : 

1. In the chronic forms of phthisis {fibroid lung). When the expec- 
toration is abundant, and when the cough is troublesome, its inhalation 
used both night and morning will generally lessen the expectoration 
and allay the cough. 

2. In children six to ten years of age, who after meals, or, inde- 
pendently of them, on exposure to cold, are seized with hoarseness, a 
hoarse, hollow cough, and some wheezing at the chest. This affection, 
involving the larynx, trachea, and larger bronchial tubes, and often 
proving very obstinate, is apt to return, aud to persist a considerable 
time. 

3. In some epidemics of diphtheria the inhalation recommended, by 
Dr. Waring-Curran is of value, and consists of 4 grains of iodine and 
4 ounces of water. A teaspoonful of this should be added to boiling 
water, and kept hot by a spirit lamp, whilst the steam is inhaled. As 
the patient becomes accustomed to the iodine the quantity of the solu- 
tion may be increased till half an ounce of it is used at each inhalation. 
It should be repeated many times a day, and each inhalation continued 
from 8 to 12 minutes. 

4. Some persons suffer with itching of the nose, of the inner canthus 
of one or both eyes, sneezing, running at the nose of a watery fluid, 
weeping of the eyes, and severe frontal headaches, and these patients 
of various ages are greatly troubled, often for many years, with daily 
attacks of this character lasting, it may be, several hours. Iodine 
inhaled often removes this affection at once, lessening the headache and 
discharge from the nostrils. Its effect is most marked in respect to the 
itching. 

Ringer generally adopts the following simple, handy, cleanly, and 
effectual plan of inhalation : Heat well a jug capable of holding about 
two pints, by rinsing with boiling water, then partly fill with boiling 
water, into which pour 20 to 30 drops of the tincture of iodine, then 
direct the patient to put his face over the mouth of the jug and breathe 
the iodized steam, covering the head to prevent the escape of the vapor. 
This inhalation should be used night and morning for five minutes, 
or a little longer. Occasionally an excess of iodine will temporarily 
produce a sensation of soreness in the chest and throat, accompanied 
with redness of the conjunctiva, running from the nose, and pain in 
the head. 

In some cases of acute coryza much relief may be obtained by sniff- 
ing the iodine from a bottle, as in the use of " smelling salts." The 
heat of the hand is sufficient to disengage the vapor in proper quantity. 

Administration. — Iodine is never used in solid form, and it has 
been taught that the tincture (Tinctura Iodi, U. 8. and B. P.) should 
not be given internally, on the ground that it is precipitated in the 
stomach. Whether this be true or false, it is a fact that the tincture 



206 DRUGS. 

has recently been largely used in the vomiting of pregnancy with 
very good results. The dose is 5 to 10 drops, well diluted. Under 
the name of Lugol's Solution {Liquor lodi Compositus, TJ. S.) iodine 
is frequently used internally; the dose is 5 to 10 drops, iu water. 
The B. P. preparations not official in the TJ. S. P. are the liniment 
(Linimentum lodi), the solution (Liquor Lodi), and Vapor Lodi, which 
is prepared by adding 1 fluidrachm of iodine to 1 fluidounce of water, 
which is gently heated, and the rising vapor inhaled. 

Within recent years a so-called colorless tincture of iodine has been 
sold which has obvious advantages and is made by the following 
process, according to Curtmann and Aiken, of St. Louis : Take of 
iodine 1J ounces, alcohol 13 fluidounces, of stronger water of ammonia 
3 fluidounces. Dissolve the iodine in the alcohol and add the ammonia. 
Allow to stand for four weeks with repeated shaking. Or the prepara- 
tion may be made hastily by using an excess of ammonia and afterward 
cautiously adding enough hydrochloric acid to render the liquid only 
feebly alkaline. Iodide of nitrogen may be precipitated, which is 
explosive. 

Unguentum Lodi, TJ. S. and B. P., is used locally over enlarged 
glands. In the case of children or adults who have delicate skins the 
ointment should be diluted one-half with lard. 

Contra-indications. — Iodine is contra-indicated in renal diseases, 
except in small doses, during the progress of acute inflammation, and 
whenever tissues are rapidly undergoing degenerative changes. 

Hydriodic Acid. 

• 
Hydriodic Acid is employed for precisely the same purposes as 

iodine itself. It is used almost entirely in the form of the official 

syrup (Syrupus Acidi Hydriodici, TJ. 8.), w T hich is a syrupy clear liquid 

containing 1 per cent, of absolute hydriodic acid. Sometimes the 

syrup has a light straw color. Syrup of hydriodic acid should be 

kept in a dark place and not exposed to the air. The dose is J to 2 

drachms well diluted with water. The advantages claimed for 

hydriodic acid are activity, its agreeable taste as compared to iodide 

of potassium, and the rarity with winch it disorders the stomach. 



IODOFORM. 

Iodoform (Iodoformum, TJ. 8. and B. P.) occurs in small saffron- 
colored crystals which possess a powerful characteristic penetrating 
odor, and strong taste. It is soluble in alcohol, ether, chloroform, 
benzol, and in fixed and volatile oils, but is insoluble in water. 

Physiological Action. — When iodoform is absorbed from the 
stomach, or from the skin from surgical dressings, it induces a train 
of serious and curious symptoms. Within half an hour iodine 
appears in the urine, and the evidences of its action assert themselves 
in one of two ways. One set of symptoms resembles meningitis. 



IODOFORM. 207 

The face is suffused, the pupils contracted, the respiration stertorous, 
and the pulse slow and full, or rapid. Delirium of the wildest 
character may ensue so that the patient tears everything within reach. 
In another class of cases the symptoms resemble those of cerebral 
congestion in the flushed face, contracted pupils, slow breathing, and 
low muttering delirium or perfect vocal quiet. Widespread fatty 
degeneration is found at the autopsy. 

The resemblance of the symptoms to cerebral congestion or menin- 
gitis should not mislead the physician into the belief that any head 
injury is present when a limb has been dressed with iodoform after an 
accident. 

Locally applied to mucous membranes the drug possesses very dis- 
tinct anaesthetic power. 

Therapeutics. — Iodoform is used chiefly as a surgical dressing. It 
is antiseptic, but not germicidal. Germs may be found in powdered 
iodoform, and will even grow in it. The drug does good by absorb- 
ing the liquids of the wound, and thereby removing the nidus for 
germ growth ; and when applied to large moist surfaces gives off free 
iodine and acts as well as a protective. 

In syphilitic sores the following dressing will be found of great 
service : Iodoform, 20 grains ; oil of eucalyptus, J fluidounce ; or, a 
powder of — Iodoform \ an ounce, camphor 75 grains, and essence of 
roses 2 drops, may be employed. In eczema, with tingling and itch- 
ing, the following application will give relief (Einger) : 

R . — Iodoformi gr. iv. 

Olei eucalypti f ^j. 

Petrolati gj. M. 

S. — Apply locally. 

Internally, iodoform is used in tertiary syphilis in all its forms, 
in the dose of from 1 to 5 grains. Bartholow recommends it most 
highly in catarrhal jaundice and in the early stages of hepatic cir- 
rhosis ; indeed, he thinks its persistent use in small dose will cure this 
affection. 

Used by means of a powder-blower it will often relieve the 
hoarseness and discomfort of laryngeal phthisis. Sometimes a spray 
may be used, which should consist of spirits of turpentine and sweet 
oil, half and half, and contain 2 grains of iodoform to each ounce. 
This mixture may also be used in bronchial catarrh to lessen the cough 
and foetid discharge. In the early stages of phthisis several clinicians 
claim to have reached very good results by the daily hypodermic in- 
jection into the back of 30 minims of a 1 to 100 solution of iodoform 
in oil of sw T eet almonds. 

In fissure of the anus 5 grains of iodoform in a suppository may 
be placed in the rectum, and after it has remained there a few minutes, 
defalcation may be had without pain. The pain following operations 
on the female perineum may also be much relieved in this manner. 

Administration. — The ointment ( Unguentum Iodoformi, U. S. and 
B. P.) is useful when applied over foetid sores. The drug itself may 



208 DRUGS. 

be given in 1 to 5-grain closes three times a day. The suppositories 
(Suppositoria Iodoform!) are official in the B. P. ; each one contains 3 
grains of iodoform. 

IODOL. 

This is a dark, dirty-yellowish-looking powder, soluble in alcohol, 
ether, and oils, but only slightly so in water. Its uses in medicine 
are identical with those of iodoform, and it possesses the advantage of 
being not so penetrating in odor as the latter drug. 

In tubercular laryngitis the powder may be blown into the larynx 
without disagreeable results and with a favorable effect on the diseased 
process. Cerna has found iodol of very great service in diabetes when 
given internally, in the dose of from 2 to 6 grains three times a day, 
and it is said to be of value in tertiary syphilis in the same quantity. 

A very useful antiseptic dressing for small wounds and abrasions is 
made by adding 1 part of iodol to 10 parts of ether and 5 of gun- 
cotton, thereby preparing an iodol collodion. 



IPECACUANHA. 

Ipecacuanha, U. 8. and B. P., or Ipecac, is the root of Cephaelis 
Ipecacuanha, a small shrub of Brazil. It contains an alkaloid, eme- 
tine, and ipecacuanhic acid. 

Physiological Action. — Locally applied to mucous membranes ipecac 
acts as an irritant, and if applied for a long period to the skin produces 
vesicles and irritation. Very minute doses have little noticeable effect, 
but large ones produce nausea, relaxation, vomiting, free secretion 
into the bronchial tubes, and a profuse now of saliva. The emesis is 
due both to the irritation of the stomach and to an effect upon the 
vomiting centre in the medulla. 

If emetine is given in lethal dose death is due to failure of respi- 
ration. 

Therapeutics. — Ipecac is used as an emetic where a fairly rapid 
action is required. It is particularly useful in cases where the stomach 
of a child is overloaded with food. In cases of poisoning it is hardly 
active or rapid enough as an emetic and is not as good as mustard or 
sulphate of zinc. In babies and young children an attack of bron- 
chitis often causes digestive disorders, by reason of the mucus coughed 
up from the lungs being at once swallowed instead of spit out of the 
mouth. In these cases the stomach may be relieved and the state of 
the lungs improved by the use of an emetic dose of syrup of ipecac. 
(Dose, 2 to 3 drachms.) Often if the dose be not large enough to 
produce emesis it will purge the child and remove the mucus by the 
bowel. 

In obstinate vomiting small doses of ipecac will act as a most suc- 
cessful cure, provided that the vomiting is due not to inflammation and 
excitement, but to depression. The irritant effect of the ipecac 



IPECACUANHA, 209 

stimulates the depressed organ up to a normal tone. The proper dose 
of ipecac for this purpose is J to J a grain or less, every half-hour 
until five or six doses are takeu. 

In some cases of the vomiting of pregnancy it is very useful, in 
others it utterly fails. One drop of the wine or one or two grains of 
the powdered ipecac is all that should be used. In vomiting with 
flatulence, either ipecac or mix vomica is of service. In the morning 
vomiting of drunkards, ipecac is of service, but it is not so good a 
remedy as small amounts of arsenic or hydrochloric acid. 

In true acute dysentery, ipecac is the best remedy we possess. 
When the passages are large and bloody and the disease is malignant, 
as it occurs in the tropics, ipecac should be given in the following 
manner : The powdered ipecac is to be administered in the dose of 60 
grains at once to produce vomiting. After vomiting has taken place, 
small doses of 3 grains are to be given every hour and continued 
until a profuse black stool is passed. The passage of this stool is a 
most favorable prognostic sign, and its non-appearance is equally 
significant of danger. Vomiting is to be controlled with opium and 
stimulants are to be freely used to avoid great depression. 

In choleraic diarrhoeas and cholera morbus ipecac is often of great 
service in the dose of 3 grains every two hours. No less a person 
than the great Trousseau asserted that ipecac was a haemostatic, and 
it is said to be the most effective remedy in haemoptysis in small 
doses. 

As an expectorant, ipecac is to be used in the early stages of bron- 
chitis, to act as a sedative to the inflamed mucous membrane and to 
promote secretion. Under these circumstances it is best combined 
with citrate of potassium (see Bronchitis). 

Ringer and Murrell have found that inhaling ipecac spray is very 
useful in chronic winter cough or bronchitis, particularly when there is 
present shortness of breath. The pure wine may be used in a spray 
apparatus, or be diluted one-half with water. While the throat may 
seem temporarily worse, the shortness of breath rapidly decreases, and 
a great improvement takes place in the cough. In order to prevent 
the wine which collects in the mouth from being swallowed, the 
patient should be directed to rinse his mouth thoroughly every few 
minutes lest nausea and vomiting be produced. The inhalation should 
not last at first over three or four minutes, and, until it is known how 
well the patient will bear the application, the wine should be diluted 
twice or thrice. 

Administration. — The syrup (Syrupus Ipecacuanhas, TJ. S.) is given 
in the dose of J to 1 drachm as an expectorant, or in the same dose 
as an emetic to an infant. The wine ( Vinum Ipecacuanhas, TJ. S. and 
B. P.) is given in the same dose as the syrup, the fluid extract (Ex- 
tractum Ipecacuanhas Fluidum, TJ. S.) in the dose of 30 drops as an 
emetic to an adult, and the troches (Trochisci Ipecacuanhas, TJ. S. and 
B. P.), J of a grain each. Troehisci Morphinas et Ipecacuanhas, TJ. S. 
and B. P., containing -^ of a grain of morphine and ^ of a grain of 
ipecac, are used in sore-throat, dissolved in the mouth. Dover's powder 

14 



210 DRUGS. 

(Pulvis Ipecacuanhas et Opii, U. S., Pulvis Ipecacuanhce Compositus, 
B. P.) is given in the dose of 5 to 15 grains. It contains 1 grain of 
opium, 1 grain of ipecac, aud 8 grains of sugar of milk. (See Opium.) 

Emetine may be given in the dose of y 1 ^ to \ grain as an emetic. 

The pill of ipecac and squill (Pilula Ipecacuanhce cum Scilla, B. P.) 
is given in the dose of 5 to 10 grains. 



IRON. 

Iron (Ferrum, U. S. and B. P.) is a metal aud a food. A food 
because it forms part of the body wheu taken into the organism and 
is used by the system in the making of blood. The number of its 
official salts and compounds is absurd, and half the list is rarely, if 
ever, used. 

Physiological Action. — Iron has little or no eifect upon the system 
when given in a single dose, but repeated doses cause an increase in 
the number of red blood-corpuscles, and plethora, or an increase in the 
quantity and quality of the blood. Iron is eliminated from the system 
by the liver, aud perhaps by the kidneys. If given in excessive doses 
it is changed into the sulphide in the bowels, and escapes with the 
feces. It has been asserted that it is never released from the body, 
but this is untrue. Whether it acts as a stimulant to blood manu- 
facture, or simply supplies the glands with blood-making material, 
we do not know. Iron probably increases the activity of the body 
to some extent, and thereby causes oxidation to go on more rapidly 
by reason of its peculiar power of converting oxygen into ozone. The 
studies of Skvortzoff are interesting in connection w T ith this subject. 
He found : 1. That iron has no marked influence on nitrogenous meta- 
morphosis in the healthy body. 2. The ingestion of iron in daily 
doses of 0.02 to 0.03 gramme (0.3 to 0.5 grain) causes a very slight 
decrease in the assimilation of the nitrogenous portions of the food. 
3. After bleeding, the assimilation of nitrogenous substances increases 
a little, whether iron is used or not ; but if iron is used at this time 
the haemoglobin is rapidly reproduced, and the drug would seem to be 
of value in restoring the bodily weight. 

The preparations of iron consist in the soluble and insoluble salts 
or forms. Of these the insoluble are better than the soluble, because 
nearly all the soluble salts of iron are precipitated by the gastric juice 
and have to be slowly redissolved. 

Therapeutics. — The chief indications for iron is ancemia (see 
Anaemia), and its chief contra-indication is plethora. When used in 
small dose (j- to 1 grain), it is quite as efficacious as in large amounts, 
and less apt to disorder the stomach. In some cases of anaemia of a 
semi-pernicious type large doses of iron are really needed, probably 
because the system is deranged in such a manner that an excessive loss 
or destruction of iron is constantly present. Large doses compensate 
for this leakage and afford the quantity needed for physiological pur- 
poses. It should not be used as a tonic unless' some direct indication 



IRON. 211 

for its employment is present, and no drug is more abused in this 
respect than iron. As each of its preparations possesses some pecu- 
liarity, the use of each will be considered separately. 

Ammonio-ferric Alum. 

Ammonio-ferric Alum (Ferri et Ammonii Sulphas, U. S.) is often 
given in cases of atonic leucorrhcea in the dose of 2 to 5 grains. It is 
quite astringent. 

Aromatic Mixture of Iron. 

The Aromatic Mixture of Iron (Mistura Ferri Aromatica, B. P.) 
contains so little iron that it should not be administered in cases where 
a chalybeate influence is desired ; it is, however, a useful tonic, given 
in the dose of 1 to 2 fluidounces. Aromatic mixture of iron contains 
cinchona bark, calumba, cloves, iron, compound tincture of cardamoms, 
tincture of orange peel, and peppermint water. 

Arseniate of Iron. 

Arseniate of Iron {Ferri. Arsenias, B. P.) is used in the dose of 
TS t° A g ra i n in ansemic subjects who are suffering from skin diseases. 

Basham's Mixture. 

Under the name of Basham's Mixture (Mistura Ferri et Ammonii 
Acetatis, U. S.), a very useful and elegant preparation of iron is em- 
ployed. It is made up as follows : 

Tincture of chloride of iron ... 2 parts. 

Dilute acetic acid 3 

Spirit of Mindererus 20 

Elixir of orange . . . . .10 

Syrup . 15 

Water. 50 

The dose is from 1 to 8 drachms well diluted, and it acts as a 
diuretic, diaphoretic, and chalybeate. 

Bromide of Iron. 

Bromide of Iron (Ferri Bromidum) is said by Da Costa to be useful 
in ancemia, when this state is associated with chorea, in the dose of 5 to 
20 grains given in syrup. In other nervous diseases accompanied by 
anaemia and insomnia the syrup of the bromide of iron (Syrupus Ferri 
Bromidi, U. S.) is useful in the dose of J to 1 fluidrachm. 

Carbonate of Iron. 

The Carbonate of Iron (Ferri Carbonas Saccharatus, U. S. and 
B. P.), is very slightly astringent, and may be used in pill form under 
the name of Pilu Ice Ferri Composite, U. S., or in Griffith's pills, which 



212 DRUGS. 

also contain myrrh. The dose is 3 grains, and this preparation of iron 
may be largely used for the treatment of amenorrhoea dependent upon 
anaemia. Under the name of Mistura Ferri Composita, U. S. and 
B. P., we have a liquid preparation used for the same purposes as the 
pills, in the dose of 1 to 2 tablespoonfuls. Pilula Ferri Carbonatis, 
B. P., are given in doses amounting to 5 to 20 grains. 

Chloride of Iron. 

Tincture of the Chloride of Iron (Tinctura Ferri Ohloridi, U. S.), 
often called tincture of the muriate of iron, is one of the best and most 
useful preparations of iron that we have. It is the most diuretic 
preparation of iron. This diuretic effect does not depend upon 
the presence of a muriatic ether, as has heretofore been taught, since 
hydrochloric ether is not present, and is hard to prepare except there 
is an excess of chlorine present. According to some researches of Dr. 
S. Weir Mitchell, the only ether present is nitrous ether, and this is 
devoid of power and in small quantity. As chloride of iron itself is 
diuretic, it is probably upon this that the diuresis produced by it 
depends. The dose of the chloride of iron (Ferri Ohloridum, U. S.) 
is l*to 3 grains. Tincture of the chloride of iron is considered a 
specific in erysipelas, and should be given in very full dose and 
frequently repeated if it is to be of any service. Ten drops every 
hour is not too much. In chronic B right's disease it is of value and 
decreases the albuminuria. In anozmia it is useful, and owing to its 
acid is a doubly effective tonic. In cases of slight ausemia in which 
very great arterial pressure exists Dr. Mitchell uses a purely milk 
diet, and an ounce of an old tincture of iron in the twenty-four hours. 
While he recognizes the fact that iron preparations are generally sup- 
posed to raise blood-pressure, he asserts that in this instance the blood- 
pressure is lowered. The dose of Liquor Ferri Ohloridi is 4 to 10 
drops. It is rarely used internally, but chiefly as an astringent of 
great power. Liquor Ferri Ohloridi is identical with Liquor Ferri 
Perchloridi, B. P. Tinctura Ferri Perchloridi, B. P., is used inter- 
nally in the dose of 10 to 20 minims. 

As a local application tincture of the chloride of iron is useful in 
diphtheria and membranous croup, and even in tonsillitis. Iu each of 
these maladies large doses of the tincture internally with counter-irri- 
tation over the neck are most useful. When used internally it should 
be well diluted and taken through a glass tube to protect the teeth. 
The strong solution of perchloride of iron (Liquor Ferri Perchloridi 
Fortior, B. P.) is a powerful styptic. 

Citrates and Tartrates of Iron. 

The four citrates of iron are soluble in water and very useful for 
this reason. Ferri Oitras, U. S., and Ferri et Ammonii Oitras, U. S. 
and B. P., occur in garnet-red scales and are given in the dose of 5 
grains. The solution of the citrate of iron (Liquor Ferri Citratis, 



IRON. 213 

TJ. 8.) is given in the dose of 10 minims. The Ferri et Quinince Citras, 
TJ. 8. and B. P., and the Ferri et Strychnines Citras, TJ. S. and B. P., 
are given in the dose of 5 to 15 grains and 1 to 3 grains respectively. 
The solution of iron and quinine [Liquor Ferri et Quinince Citratis, 
TJ. 8.) is given in the dose of 8 to 15 minims. 

Besides these citrates there are two tartrates — Ferri et Ammonii 
Tartrate, TJ. 8., and Ferri et Potassii Tartras, TJ. 8. ; and Ferrum Tar- 
tar alum, B. P., all given in the dose of 5 grains. 

Dialyzed Iron. 

Dialyzed Iron (Ferrum Dialyzatum) is a very feeble preparation of 
iron, lacking in astringency, easily precipitated from the solution in 
which it occurs, but largely used in ancemia by some practitioners. 
The dose is 10 to 20 drops in water three times a day. Sometimes 
river water, if it contains much inorganic or organic matter, will pre- 
cipitate it. Owing to the instability of dialyzed iron it may be used 
without any preparation as an antidote to arsenic. Liquor Ferri 
Dialyzatus, B. P., is given in the dose of 10 to 30 minims. 

Hydrated Sesquioxide of Iron. 

Hydrated Sesquioxide of Iron (Ferri Oxidum Hydratum, TJ. S.) is 
the antidote to arsenic, but to be efficacious it must be freshly prepared. 
It is to be made by precipitating any liquid preparation of iron by 
the addition of an alkali such as ammonia, or by the addition of mag- 
nesia. If ammonia is used, the precipitate has to be washed with 
water several times to get rid of the alkali, which will render the 
antidote too irritant to be swallowed if it is allowed to remain with 
the precipitate. Magnesia is an antidote in itself and should be 
preferred under all circumstances. The antidote should be given in 
excess and as much as a pint of the iron solution should be precipi- 
tated. The magnesia should be freely added, as too much of it 
cannot be given. The official antidote to arsenic is Ferri Oxidum 
Hydratum cum Magnesia, TJ. 8. In the Prussian Pharmacopoeia 
this is known as the Antidotum Arsenici. (See Arsenic.) 

Iodide of Iron. 

The Syrup of the Iodide of Iron (Syrupus Ferri Lodidi, TJ. 8. and 
B. P.) is a transparent liquid of a sweet, iron-like taste. It should 
contain no free iodine, and if it strikes a blue color with starch should 
be discarded. It is largely used in anaemia associated with scrofulosis 
and struma, and is useful in the eczema of young children when this 
is dependent upon lack of vitality or anaemia. The dose to a child 
of two years is 2 to 3 drops well diluted, and to an adult 30 to 40 
drops in water, to be taken through a glass tube to protect the teeth. 

The saccharated iodide of iron (Ferri lodidum Saccharatum, TJ. 8.) 
is used in place of the syrup in the dose of 2 to 5 grains. The 



214 DRUGS. 

official pills (Pllula Ferri Iodidi, TJ. #.and B. P.) each contain -J- of 
a grain of reduced iron and J- of a grain of iodine, and are given in 
the dose of 1 to 3 pills. 

Lactate of Iron. 

The Lactate of Iron {Ferri Lactas, TJ. S.) is soluble in forty-eight 
parts of water, and is given in the dose of 5 grains. It is used for 
the same purposes as the other preparations of iron. Lactate of iron 
is one of the ingredients of Syrupus Hypophosphitum own Ferro, TJ. S., 
the dose of which is J to 1 fluidrachm. 

Ferri Subsulphas, or Monsel's Salt. 

Monsel's Solution (Liquor Ferri Subsulphatis, TJ. S.), sometimes 
wrongly called the solution of the persulphate of iron, is one of the most 
powerful styptics or haemostatics that we have. It is never to be em- 
ployed where a haemorrhage is to be attacked through the circulation, 
but only when the solution can come in direct contact with the bleeding 
spot. The objection to its use is the heavy, black, and dirty clot which 
it forms on coming in contact with the blood. In hcemoptysis Monsel's 
Solution should be used in fine spray consisting of from 10 to 60 drops 
to the ounce of distilled water. In uterine hemorrhage from any cause 
the dilution may be half-and-half, or if the hemorrhage be from a 
polypus or the cervix uteri the pure solution should be used, locally 
applied. . In nose-bleed Monsel's Solution may be employed diluted 
one-half or pure, but it is disagreeable because of the hard, black clot 
which is formed and the uncomfortable sensations and pain produced 
in the nasal chambers. Plugging the nostrils with pledgets of cotton 
is generally sufficiently efficacious. 

En the intestinal haemorrhage occurring during or after typhoid fever 
Monsel's Solution has been given, but ought not to be, as it is decom- 
posed in the stomach before it reaches the intestine. Monsel's Salt 
(Ferri Subsulphatis) should be given in pills of 3 grains each, the 
pills being made hard enough to escape into the intestine before the 
stomach breaks them down. One, two, or three pills may be given 
and repeated in an hour. Hematemesis due to bleeding in the 
stomach should be treated by 3-drop doses of the solution in a little 
water. 

In tonsillitis and pharyngitis a most efficient application is pure 
Monsel's Solution applied by means of a pledget of cotton or camel's- 
hair brush ; or equal parts of the solution and glycerin may be used. 
This application is often as painful as it is efficient. In diphtheria 
this method of treatment is often of great service. The antidote to 
Monsel's Solution is common soap. 

Oxalate of Iron. 
Oxalate of Iron (Ferri Oxalas, TJ. 8.) is given in the dose of 2 to 3 



IRON. 215 



Phosphates of Iron. 

There are two phosphates of iron, Ferri Phosphas, TJ. S. and B. P., 
and Ferri Pyrophosphas, TJ. S. The first of these is insoluble and 
is rarely used. The second is quite soluble and useful in the dose oi 
2 to 5 grains. Syrupus Ferri Phosphatus, B. P., is given in the dose 
of 1 fluidrachm. Phosphate of iron is one of the ingredients of the 
syrup of iron, quinine, and strychnine {Syrupus Ferri, Quinince et 
Strychnince Phosphatum, TJ. S.), and is given in the dose of 1 fluid- 
drachm. 

Reduced Iron. 

Quevenne's Iron {Ferrum Beductum, TJ. S. and B. P. ) is an iron- 
gray or reddish powder which is frequently adulterated with lamp- 
black. If it is pure it should burn in sparks when dropped into a 
flame, but if lampblack is present this will not occur. It should also 
yield no sulphuretted hydrogen on adding sulphuric acid to it. It is 
tasteless, and may be given to children for this reason in pills or 
gum-drops, or placed inside of small chocolate creams, or in the form 
of troches (Trochisci Ferri Bedaeti, B. P.), each lozenge containing 
1 grain of the reduced iron. It is used solely in ausemia and is one 
of the least astringent of the iron preparations. 

Sulphate of Iron. 

Sulphate of Iron {Ferri Sulphas, TJ. S. and B. P.) is used inter- 
nally in the dose of 5 grains in pill form in chronic diarrhoea. Ex- 
ternally, in a solution of the strength of 5 to 25 grains to the ounce, 
it is used as an astringent lotion. Two other forms of the sulphate 
are also employed, namely, the dried {Ferri Sulphas Exsiccatus, TJ. S. 
and B. P.) and the precipitated {Ferri Sulphas Prascipitatis, TJ. S.) or 
{Ferri Sulphas G-ranulata, B. P.), each of which is given in the dose 
of 3 grains. 

Valerianate of Iron. 

Valerianate of Iron {Ferri Valerianas, TJ. S.) is sometimes useful 
in hysteria with anaemia, given in the dose of 1 grain or more. 

Wines of Iron. 

The Bitter Wine of Iron ( Vinum Ferri Amarum, B. P.) is useful 
in ancemia, both in children and adults, and may be advantageously 
accompanied with cod-liver oil. It is given in a dose of 1 to 2 fluid- 
drachms or more. This wine is composed of soluble citrate of iron 
and quinine, tincture of sweet orange-peel, syrup, and stronger white 
wine. 

Wine of the Citrate of Iron, or Vinum Ferri Citratis, TJ. S., is com- 
posed of the citrate of iron and ammonium, tincture of sweet orange- 
peel, syrup, and stronger white wine. The dose is identical with that 
of the bitter wine, and it is used for the same purposes. 



216 DRUGS. 

Hydrated Peroxide of Iron (Ferri Peroxidum Hydratum, B. P.) 
is used in the dose of 5 to 30 grains. From the last preparation 
iron plaster (Emplastrum Ferri, B. P.) is made. The plaster of iron 
official in the TJ. 8. is prepared from the hydrated oxide of iron. 

The following preparations of iron are also official : Liquor Ferri 
Acetatis, TJ. $., dose 15 minims to 1 fluidrachm ; Liquor Ferri 
Acetatis Fortior, B. P., dose 1 to 8 minims; and Basham's Mixture 
(see page 211). 

Untoward Effects of Iron. — Iron is apt to cause gastric distress and 
frontal headache in persons who are susceptible to its use. Even one 
dose will cause this trouble in some persons. In many instances the 
frontal headache will be found to be due to the constipation which has 
been brought on by the iron, and will be relieved if mild laxatives or 
purges are used. The state of the bowels should always be watched 
and laxatives given whenever constipation is present and iron is being 
administered. In rheumatic and gouty persons frontal headaches are 
a common symptom when iron is given, and purgatives will not gen- 
erally give relief. Garrod and Haig have shown that iron decreases 
the elimination of uric acid, which may account for the production of 
headache in the case of rheumatic patients under its influence. Some- 
times salts of iron produce vesical irritation and a constant desire to 
urinate, causing mucus to form in abnormal amount in the bladder. 
In children its use may result in nocturnal incontinence of urine. 



JALAP. 

Jalap (Jalapa, TJ. S. and B. P.) is the root of Exogonium Purga, 
a native of Mexico. It contains two resins, jalapin and convolvulin, 
neither of which is used in medicine by itself, though both of them 
enter into the Resin of Jalap of the TJ. S. P. In overdose jalap or its 
resin causes vomiting and purging, with gastro-enteritis. 

Therapeutics. — Jalap is used in medicine as a hydragogue purge to 
relieve dropsy of any origin. It may be used to deplete in cases of 
general plethora with cerebral congestion, and owing to its tastelessness 
is a useful cathartic in children if given in the proper dose, namely, 
1 to 2 grains in half an ounce of syrup of rhubarb. Combined with 
calomel it is preferred to all other purges by some practitioners, par- 
ticularly if the liver is torpid. 

Administration. — Jalap may be given in the form of the compound 
powder (Pulvis Jalapce Compositus, TJ. S. and B. P.), dose 15 to 40 
grains ; as the abstract (Abstraction Jalapo3, TJ. $.), dose 5 to 15 grains ; 
and the resin (Besina Jalapce, TJ. S. and B. P.), dose for an adult, 2 to 
4 grains. Owing to the small size of the dose of the resin and its 
lack of taste, this preparation is to be .preferred for children in the 
dose of J to J- a grain. The tincture (Tinctura Jalapaz, B. P.) is 
given in the dose of | to 1 fluidrachm ; the extract (Extraction 
Jalapo3, B. P.) is used in the dose of 5 to 15 grains. 



JUNIPER. 217 



JEQUIRITY. 

This is a plant known as Abrus Precatorius, the seeds of which are 
poisonous. Jequirity is never used internally in medicine in this 
country. In the proportion of 8 grains of the powdered seeds to an 
ounce of distilled water, jequirity is sometimes dropped into the eye in 
cases of chronic granular conjunctivitis, in order to produce an acute 
diphtheritic inflammation which will so change the chronic process 
present as to permit of a cure. The solution undergoes decomposition 
with great rapidity, and should be prepared freshly each time it is 
used, or 4 to 8 grains of boric acid should be added to preserve it. 
The drug is a powerful cardiac depressant poison. 



JUNIPER. 

Juniperus, TJ. S., is the fruit or berry of Juniperus Communis, an 
evergreen of Northern Europe and America. It contains a volatile 
oil aud an amorphous principle, juniperin. 

Physiological Action. — Juniper acts as a gastric stimulant and 
touic, as a mild diaphoretic if combined with alcohol, and as a marked 
stimulating, exciting diuretic. It escapes from the body by the 
kidueys. 

Therapeutics. — Juniper is valuable as a stimulant to the genito- 
urinary system whenever it is depressed or chronically diseased, as in 
chronic pyelitis, nephritis, and chronic catarrh of the bladder. In con- 
gestion of the kidneys, if not accompanied by active tissue changes, it 
relieves these organs and does away with albuminuria. Used after 
an attack of acute Bright 's disease, when reaction has set in and the 
secreting epithelium of the kidney is atonic, it is of value, but care 
should be taken that all inflammation has passed by, or it will make 
the patient worse. In the later stages of scarlet fever, in which the 
renal condition corresponds to that just described, juniper is useful. 
In old persons a sensation of weight .across the lumbar region is often 
readily removed by the use of juniper if the kidneys are inactive. 

Administration. — Juniper is used in the form of the compound 
spirit (Spiritus Juniperi Compositus, TJ. S.), composed of the oils of 
juniper, caraway, and fennel, combined with alcohol and water, in the 
dose of 1 to 4 drachms. Gin is virtually identical with the compound 
spirit. The infusion of juniper is made by adding an ounce of the 
berries to a pint of boiling water and allowing it to stand in a warm 
place for an hour. The entire quantity is to be taken in twenty-four 
hours, and the infusion is often combined with acetate of potassium or 
an ounce of the bitartrate of potassium in the treatment of dropsy. 
The spirit {Spiritus Juniperi, TJ. 8. and B. P.) is given in the dose of 
30 minims to 1 drachm. The oil [Oleum Juniperi, TJ. S. and B. P.) 
is used in the dose of 1 to 4 minims. 



218 DRUGS 



KAMALA. 



Kamala, TJ. 8. and B. P., or Rottlera, as it is sometimes called, is 
the hairs and bristles from the capsules of Rottlera Tinctoria, a plant 
of Abyssinia, India, and China. It contains an active principle, 
rottlerin, which is not official. Given in the dose of 1 to 2 drachms 
kamala acts as a drastic and as a remedy for tapeworm. It should 
be administered in syrup, and repeated in eight hours if no effect is 
produced. (See Worms.) 

KAOLIN. 

Kaolin is a soft white powder and is a decomposition product of 
mineral deposits containing feldspar. It is used externally as a dust- 
ing powder in eczema. 

KINO. 

Kino is the inspissated juice of the Plerocarpus Marsupium, a tall 
tree of India. It contains kino-tannic acid and is used as an astrin- 
gent in serous diarrhoea. It is official in the form of the tincture 
(Tinctura Kino, TJ. 8. and B. P.) and is given in the dose of 1 fluid- 
drachm. Kino may be used as a gargle in sore-throat and for relax- 
ation of the uvula. Under the name of compound powder of kino (Pul- 
vis Kino Compositus, B. P.) an efficient and pleasant anti-diarrhoea 
powder is used. This powder is not official in the TJ. 8. P. The 
formula for each powder is 15 grains of powdered kino, 4 of powdered 
cinnamon, and 1 of powdered opium. 



KRAMERIA. 

Krameria, TJ. 8., Krameria Radix, B. P., sometimes called Rha- 
tany, is the root of Krameria Triandra and Krameria Tomentosa, 
shrubs of Peru and New Granada, and is employed in serous diar- 
rhoeas with good effect. The tincture {Tinctura Kramerioe, TJ. 8. and 
B. P.) is given in the dose of 1 drachm, the solid extract (Extractum 
Kramerioe, TJ. 8. and B. P.) 5 to 10 grains, the fluid extract (Ex- 
tractum Kramerioe Fluidum, TJ. 8.), dose 10 to 20 drops, and the syrup 
(Syrupus Kramerioe, TJ. S), dose 1 ounce. The troches (Trochisci 
Kramerioe, TJ. 8.) are held in the mouth for the purpose of producing 
a local astringent effect. An infusion (Infusum Kramerioe) is official 
in the B. P., dose 1 to 2 ounces. 



LACTOSE. 

(See Sugar of Milk.) 



LEAD. 219 



LANOLIN. 



Lanolin is a fat derived from the wool of the common sheep, and is 
a whitish substance of peculiar stability, very difficult of saponifica- 
tion and incapable of becoming rancid. Unna states that ointments 
of acids, hydrogen peroxide, and other substances may be made by it. 
One great objection to lanolin is its stickiness, which is avoided by 
adding one-third of vaseline. Lanolin is supposed to possess very 
remarkable penetrating powers when applied to the skin in cases where 
much infiltration is present, particularly if it is combined with resorcin 
or some similar medicament. In itself it has little curative power, and 
is but little better than lard, oil, or any common fat as a basis for oint- 
ments. In some cases, which are rare, it will cause irritation of the 
skin. 

LEAD. 

Plumbum, or Lead, is a metal possessing more or less power over 
the organism according to the salts which are employed. It is not 
official as lead itself. 

Physiological Action. — Lead in one of its soluble salts, if applied 
to a mucous membrane, produces a bleaching which is particularly 
noticeable where the redness of inflammation has previously existed. 
It has little effect in single dose except by an indirect influence over 
the circulation, nervous system, or respiration. For a description of 
the effects of lead in overdoses see " Poisoning," below. 

The most irritant and poisonous salt is the nitrate, the next the sub- 
acetate, and the least poisonous of the soluble salts is the acetate. 

Acute Poisoning. — When the acetate of lead is taken in poisonous 
amounts it produces a sweet metallic taste in the mouth, followed by 
pain in the epigastrium and the vomiting of white, milky-looking 
liquids or white curds mixed with food. The white color is due to 
the presence of chloride of lead formed by the action of the gastric 
juice. 

The pain continually increases, and diarrhoea due to gastro-enteritis 
may be set up, or, in other cases, obstinate constipation is present. 
The passages are generally black, this beiug due to the presence of the 
sulphide of lead. At the same time the pulse becomes rapid, tense, 
and cord- like, but after a time weak and relapsed. The face is anxious 
and pale, or livid. The thirst is excessive and cramps in the calves of 
the legs or muscular twitchings may ensue. It is said that the char- 
acteristic blue line on the gums may appear in acute poisoning, but 
this is not based on fact. If coma comes on, death is assured. 

The treatment consists in the use of the chemical antidote, a soluble 
sulphate, in large quantity, in the administration of emetics and the 
use of the stomach-pump if the vomiting produced by the drug is 
not sufficient to rid the stomach of all the poison. The best soluble 
sulphates to employ are Epsom and Glauber salts, because they are 



220 DRUGS. 

always at hand, are readily soluble, and, in excess, act as purges, 
which will wash out the intestinal canal. Hot applications should be 
applied to the belly and feet, and the pain and irritation which is 
present relieved by opium. 

Chronic Poisoning. — Chronic lead-poisoning is rarely produced by 
the soluble salts of lead, nearly always being due to the insoluble salts. 
The symptoms of chronic lead-poison ing or plumbism are as various 
as it is possible to find variety in the signs of disease of every kind. 
There is no train of symptoms which may not occur, and the occur- 
rence of rare, anomalous symptoms in a given case should at once 
bring to the mind the thought of lead-poisoning or syphilis. Chronic 
poisoning occurs in painters, manufacturers of lead salts, and everyone 
who is largely thrown in contact with the metal in the arts. It occurs 
from the use of hair-dyes containing the acetate of lead, from drink- 
ing water which has passed through new lead pipe, and even from the 
biting of silk threads loaded with lead to increase their weight. Chro- 
mate of lead has been used to color sponge-cake, when eggs were 
thought too dear, and has killed many persons. Millers, who have 
filled the holes in grindstones with lead, have caused widespread 
epidemics of what has been called " dry cholera," and many persons 
have suffered from lead-poisoning from eating apple-butter kept in 
jars glazed with lead. 

The most prominent, but by no means the most constant symptom 
of chronic plumbism, is bilateral wrist-drop, due to palsy of the 
extensor muscles of the forearm. The short extensor of the thumb 
generally escapes the drug's influence. Sometimes internal squint 
arises from paralysis of the external rectus muscles. Another very 
common symptom is colic centering around the umbilicus and ra- 
diating through the belly and loins. Obstinate constipation often 
accompanies these symptoms, and the feces, when passed, are white 
and clay-colored. 

During an attack of lead-colic the arterial tension is increased very 
markedly, the tongue is coated and whitish, and the bowels are obsti- 
nately confined. 

If these early warnings are disregarded and the exposure to the 
lead is continued, cerebral symptoms come on, the result of encepha- 
lopathia satwnina or saturnine cerebritis. Saturnine epilepsy is not 
very rare. If convulsions come on death generally ensues. The con- 
vulsions in some cases are not due to a cerebral effect of the lead, but 
to uraemia from the renal changes which it has caused. 

Renal disease is very commonly produced by lead, and it is not 
uncommon for chronic contracted kidney to be found at the autopsy 
of a sufferer from lead-poisoning. If a patient with chronic lead- 
poisoning have a urine with a persisteut low specific gravity, the 
prognosis is grave as evidencing advanced kidney involvement. 

Asthma, due to the inhalation of lead-dust, is sometimes met with. 

The most important confirmatory evidence of chronic lead-poisoning 
is a blue line on the gums just where they join the teeth. Its absence is 
not a negative sign, however, as poisoned persons cleanly in respect to 



LEAD. 221 

their mouths often do not have it. Marked cachexia or anaemia is 
commonly seen in chronic lead-poisoning. 

After prolonged lead-poisoning the nerve-trunks are found atrophied 
and finally changed into fibrous cords. Polio-myelitis, anterior or 
posterior, may be present, and locomotor ataxia is commonly caused. 
It is said that the locomotor ataxia produced by lead may be dis- 
tinguished from the idiopathic form by the fact that in lead-poison- 
ing the sphincters are affected, while in the non-toxic variety they 
escape. 

In some cases trophic changes in the joints ensue, and plumbic 
gout is not rarely seen, or even lead arthralgia with deposits of urates 
in the joints. This condition is clue to the fact pointed out by Garrod 
and Haig, that lead forms insoluble salts with uric acid. 

Lead escapes from the body in the urine, the faeces, and all the 
secretions. It is chiefly eliminated by the liver and the bile. 

Treatment of Chronic Poisoning. — The treatment consists in 
three classes of remedial measures : 1st, the removal of the cause ; 
2d, the removal of the poison in the body ; and, 3d, the treatment of 
the lesions produced by the poison. 

In lead-colic hepatic purges, such as jalap and calomel, combined 
with opium to prevent pain, are indicated, and alum and opium, or 
morphine, are said to be almost specifics, the alum in two-grain doses, 
the others in full amounts. After all, purges fail to move the bowels 
of a person suffering from chronic lead poisoning and succeed only 
when morphine is given to overcome the intestinal inhibition produced 
by the irritation caused by the lead. 

In the cerebral inflammation of lead-poisoning a blister to the 
back of the neck, revulsives, and a pilocarpine sweat may be re- 
sorted to. 

To aid in the elimination of the lead, iodide of potassium, which 
forms double soluble salts in the tissues with the metal, is to be used, 
10 to 20 grains three times a day. 

If progressive paralysis is present, Wood insists on the use of large 
doses of strychnine at the same time that the iodide is given. The 
strychnine should not, of course, be given with the iodide, as it is 
incompatible. 

Electricity should be used as a remedy to restore lost function. 
If the faradic current makes the muscles contract it should be em- 
ployed, and, if not, the galvanic should be used. Curiously enough, 
voluntary power sometimes returns before the muscles will react at 
all to electricity. 

It is said that baths of sulphuret of potassium should be used ; 
5 or 6 ounces of the salt to each bath, which is to be given in a 
wooden tub. The patient should afterward be well soaped, then 
thoroughly rinsed off, and rubbed down with a rough towel. 

As the salts of lead are used for different purposes, the therapeutics 
of each one will be taken up separately. 



222 DRUGS 



Acetate of Lead. 

Acetate of Lead (Plumbi Acetas, U. S. and B. P.), or sugar of 
lead, has a sweet, astringent taste, and is soluble in water, although 
the solution formed is slightly milky in appearance. 

Therapeutics. — Acetate of lead may be used, and is largely em- 
ployed, in the following pill in the treatment of serous diarrhoea : 

Be . — Plumbi acetat. . . . . . . gr. xl. 

Pulv. opii gr. x. 

Camphorse . . . . . . . gr. xl. M. 

Ft. in pil. no. xx. S. — One every four hours. 

This pill may also be given in dysentery. 

Administration. — The B. P, recognizes the following preparations 
of lead acetate (Pilula Plumbi cum Opio), dose 3 to 5 grains ; Sup-, 
positoria Plumbi Composita, each suppository containing 1 grain of 
opium to 3 grains of lead acetate; and an ointment (Ungentum 
Plumbi Acetatis). 

Carbonate of Lead. 

Carbonate of Lead {Plumbi Carbonas, U. S. and B. P.) is insoluble 
and is used as a coating or dressing for burns, scalds, or ulcers, when 
rubbed up with linseed or other oil, or in the form of the ointment 
( Unguentum Plumbi Carbonatis, U. S. and B. P.). If a wide surface 
is covered with this ointment it may cause lead-poisoning by ab- 
sorption. 

Carbonate of lead may be used in the treatment of sunburn in the 
following prescription : 

R. — Plumbi carbonat gj. 

Pulv. amyli ....... ^j. 

Unguent, aquae rosse . . . . • SJ« 

Olei oliva? . . . . . . . fgij. M. 

S. — Apply to the inflamed skin. 

Iodide of Lead. 

Iodide of Lead (Plumbi Iodidum, U. S. and B. P.) is occasionally 
employed in medicine ; the dose is J to 2 grains. Emplastrum Plumbi 
Iodidi, P. B., and Unguentum Plumbi lodidi, U. S. and B. P., are 
useful as external astringent and alterative applications. 

Liquor Plumbi Subacetatis. 

Liquor Plumbi Subacetatis, U. S. and B. P., or Goulard's Extract, 
is a colorless liquid, much used externally, when diluted, with lauda- 
num, for sprains, bruises, and local inflammations, under the name of 
" lead-water and laudanum." The proportion should be 4 parts of 
the pure lead-water, diluted with 16 parts of water, to 1 of laudanum, 
but this is varied as the inflammation or pain is the more severe. 
The official liquor is also official in a dilute solution (Liquor Plumbi 



LEPTANDRA. 223 

Svbacetatis Dilutus, TJ. S. and B. P.), and, as such, is too weak for 
ordinary use, although it is commonly employed. The strong solu- 
tion should be used in the strength of from 1 to 4 ounces to the pint 
of water. This solution should never be employed if the skin is 
broken, as absorption may occur, and what is more important still, 
the drug prevents healing by constringing and whitening the edges 
of the wound. If some bread-crumbs be saturated with this solution 
and applied to an inflamed finger, a felon can often be aborted in the 
early stages. The official dilute solution is useful as a lotion in eczema 
which itches and tingles, and is not dry in character. It should be 
applied once or twice a day, and it is well to follow the applica- 
tion of the lead with a weak sulphur bath or alkaline wash. (See 
Eczema.) 

Lead-water is also useful in pruritus pudendi, and the acetate of 
lead may be used as an injection in the dose of 1 to 8 grains to the 
ounce of water in cases of gonorrhoea. The cerate (Ceratum Plumbi 
Subacetatis, TJ. S.), the liniment (Linimentum Plumbi Subacetatis, TJ. S.), 
and the glycerin (G-lycerinum Plumbi Subacetatis, TJ. S. and B. P.)> 
may be used for the same purposes as the Goulard's extract. 

Litharge. 

Litharge (Plumbi Oxidum, TJ. S. and B. P.) is used for the prepa- 
ration of lead-plaster (Emplastrum Plumbi, TJ. S. and B. P.), some- 
times called " Diachylon," and this is in turn employed for the manu- 
ture of resin-plaster {Emplastrum Resince, TJ. S. and B. P.). It is 
also used in the preparation of the solution of subacetate of lead. 

Hebra recommends for sweating of the feet an application of equal 
parts of lead-plaster and linseed oil, applied on linen, and wrapped 
around the feet every third day. 

Nitrate of Lead. 

Nitrate of Lead (Plumbi Nitras, TJ. S. and B. P.) is never used in- 
ternally but as a powder in the treatment of cases of onychia maligna, 
and in the formation of Ledoyen's Disinfecting Solution. The latter 
discolors the paint in water-closets, dissolves the solder in drain-pipes, 
and is not a good preparation for general use. 



LEPTANDRA. 

The medicinal portion of Leptandra Virginica is the rhizome and 
rootlet from which are made the official extract (Extractum Leptandrce,. 
TJ. S.) and the fluid extract (Extractum Leptandrce Fluidum, TJ. S). 
The dose of the former is from 1 to 8 grains and of the fluid extract 5 
to 40 minims. 

Physiological Action. — Very few experiments have been made as 
to the action of this remedy, and the only ones of importance are those 



224 DKCTGS. 

of Rutherford and Vignal, who found that it possessed a moderate 
influence in increasing the flow of bile. In overdose it causes violent 
purging. 

Therapeutics. — In the official preparations of leptanclra, which are 
not as active as is the fresh drug, we have excellent substitutes for 
calomel according to many clinicians. Those who have used leptandra 
also believe it to be of the greatest value in the indigestion of the intes- 
tinal type sometimes called " duodenal atony." The following pill is 
a good method of using the drug in these cases : 

R . — Ext. chirettse gr. xx. 

Ext. leptandrse gr. xx. M. 

Ft. in pil. no. x. S. — One pill after each meal. 

Under the name leptandrin we have an impure resin which is given 
in the dose of 2 to 5 grains. An alkaloid of doubtful existence is 
called leptandrine. 

LIPANIN. 

Lipanin is an artificially prepared mixture devised by Von Mering 
as a substitute for cod-liver oil, and consists in 6 parts of oleic acid 
added to 100 parts of olive oil. The advantages possessed by it are 
its lack of disagreeable odor and taste, and its ready emulsification 
and digestibility. The commeucing dose is 1 drachm, which may be 
increased to 4 drachms. This mixture has been found of value in 
most of the diseases in which cold-liver oil is employed, and in the 
opinion of the author its efficacy is greatly increased if the hypophos- 
p kites of lime and sodium are used at tke same time in the dose of 
10 grains three times a day. Iodine, or one of its compounds, may 
also be given if it is desired to exert an alterative influence. 



LIQUORICE. 

Liquorice (Glycyrrhiza, U. S., Glycyrrhizm Radix, B. P.) is the 
root of Glycyrrhiza Glabra, a plant of Southern Europe and Asia. 
It is used to increase secretion in the mouth in the form of a solid 
extract, and when dissolved in water to form a vehicle for other drugs, 
particularly if they have a disagreeable taste. The powdered solid 
extract is a very mild and useful laxative. 

Administration. — The solid extract (Extractum Glycyrrhizw, U. •#. 
and B. P.) is used in a dose anywhere from 5 to 120 grains. The pure 
extract (Extractum Glycyrrhizw Purum, U. S.) is used in the same 
quantities as the ordinary extract. The fluid extract (Extraction Gly- 
cyrrhiza3 Fluidwn, U. 8.) or the liquid extract (Extvacium Glycyrrhizoz 
Liquidum, B. P.) is used in 1 to 2-drachm doses. Under the name of 
Brown Mixture or " compound liquorice mixture/' a very efficient ex- 
pectorant solution is official (Mistura Glycyrrhizw Composita, U. S.) 
which contains as its most important ingredients 12 parts of paregoric, 



LITHIUM. 225 

6 parts of wine of antimony, and 3 parts of sweet spirits of nitre. 
The dose is 1 to 4 drachms. Pulvis Grlycyrrhiza Composita, XI. S. and 
B. P.), or compound liquorice powder, contains, according to the XI. S. P., 
18 parts of senna, 16 of liquorice, 8 of fennel, 8 of washed sulphur, 
and 50 parts of sugar. According to the B. P. it should contain 2 
parts of senna, 2 of liquorice root, 1 of fennel fruit, 1 of sublimed 
sulphur, and of sugar 6 parts. The dose is 1 to 4 drachms. It is 
largely used as an efficient laxative after childbirth and in cases which 
suffer from constipation chiefly from the inactivity consequent upon 
being in bed. The Troches (Trochisci Grlycyrrhizce et Opii, XI. S. and 
B. P.) contain 2V grain of opium and 2 grains of extract of liquorice. 
Finally we have Glycyrrhizinum Ammoniatum, XI. S., which is the sweet 
principle of liquorice rendered soluble and easily tasted by the addition 
of ammonia. The dose of this preparation is 5 to 15 grains. 



LITHIUM. 

Lithium is used in several forms, but its salts may be divided into 
two classes — those which act as lithium and those which act as the 
acids forming them. In the first class we have the carbonate (Lithii 
Carbonas, XI. S. and B. P.) dose 2 to 10 grains, and the citrate (Idthii 
Citras, XI. S. and B. P), dose 5 to 20 grains. In the second class we 
find the benzoate (Idthii Benzoas, XI. S.) dose 5 to 30 grains ; Lithii 
Bromidum, XI. S., dose 10 to 40 grains, and Lithii Salicylas, XI. S., 
dose 10 to 30 grains. 

Haig has pointed out that although lithia forms salts with uric acid 
in the test-tube, in the body it has a greater affinity for the acid sodium 
phosphate in the blood and practically leaves the uric acid to itself. 
This is an important point, since it proves that the large amount of 
water generally taken with lithia has more to do with relieving gout 
than has the lithia. 

The carbonate and citrate are used in gout and rheumatoid arthritis 
for the purpose of entering into combination with the uric acid in the 
body to form soluble urates and prevent deposits in the joints. They 
have been said to dissolve calculi, but this is untrue, though they 
are used when it is desired to render the urine alkaline. The 
carbonate is not soluble in water, and should be given in capsule or 
freshly-made pill, but the citrate is soluble. The latter may be 
made from the former by taking 50 grains of the carbonate, 90 grains 
of crystallized citric acid, and warm distilled water 1 fluidounce. 
The acid should be dissolved first aud the carbonate added to the 
solution. The solution should then be kept hot until effervescence ceases. 

In cases of diabetes depending upon a gouty taint remarkable results 
are often obtained from the use of the citrate or carbonate of lithium 
and arsenic. The dose should be ^ of a grain of arsenite of sodium 
and 10 grains of the lithium salt three times a day. 

For the use of the other salts of lithium, see the articles on the 
Bromides, Salicylic Acid, and Benzoic Acid. 

15 



226 DRUGS. 

It is worthy of note that in some cases citrate of lithium will dis- 
order the stomach and produce vomiting. Lithia water, or the prepa- 
ration of the British Pharmacopoeia, Liquor Lithice Effervescens, is 
useful in gout in quantities of 5 to 10 ounces at a time. 



LIQUOR POTASSES. 

Liquor Potassas, TJ. S. and B. P., is a solution of potassa contain- 
ing about 5 per cent, of potassium hydrate, and is a clear, odorless 
liquid of caustic taste and strongly alkaline reaction. It is used in 
medicine as an antacid and for the purpose of decreasing the acidity 
of the urine. 

In ingrowing toe-nail it is often used to soften the nail, prior to 
packing with cotton or partial evulsion. Its dose is 5 to 30 drops 
well diluted with water. 

LOBELIA. 

Lobelia, TJ. S. and B. P., is the leaves and tops of Lobelia Lnflata, a 
common weed of the United States. It contains an alkaloid, lobeline, 
and lobelic acid. 

Physiological Action. — When takeu in overdose lobelia causes 
emesis, intense prostration, a feeble pulse, pale skin, livid face, mus- 
cular relaxation and a cold sweat. Violent purging may be present. 
It is said to paralyze the motor nerve-trunks, and it causes a fall of 
arterial pressure, followed by a rise due to the asphyxia which it finally 
produces. Ultimately it paralyzes the respiratory centre and the 
peripheral vagi. The treatment of the poisoning is to administer opium 
to stop irritation and vomiting, to give alcohol and ammonia to sup- 
port the heart, and in the use of external heat. 

Therapeutics. — Lobelia is used chiefly as an anti-asthmatic and has 
been equally greatly praised and condemned by eminent authorities. 
The reason for this lies in the fact that it is generally useless in asthma 
unless given in almost poisonous dose. Wood teaches that it should 
rarely if ever be used, because of its poisonous effects even in doses 
medicinally active, while Sidney Ringer says that the drug is erro- 
neously thought to be dangerous. In asthma both of the gastric and 
bronchial form lobelia is undoubtedly of service. In some cases it 
fails as signally as it succeeds in others. If the asthma is due to or 
associated with cardiac disease lobelia should never be employed. The 
drug should be taken in the dose of J a drachm to 1 drachm of the 
tincture at the first sign of an attack, or in 10-drop doses every fifteen 
minutes until distinct nausea occurs, or relief is obtained. 

In atonic constipation, 10 drops of the tincture at bed-time are often 
of service. 

Administration. — Lobelia is given in the form of the tincture 
(Tinctura Lobelia?, TJ. S.), in the dose of 10 to 30 drops, or 1 to 2 
drachms, as an emetic. The vinegar (Acetum Lobelias, TJ. S) is given 



MAGNESIA. 227 

in the dose of 20 to 30 drops, and the fluid extract (Extraction Lobelice 
Fluidum, TJ. S.), in the dose of 1 to 5 drops, or, as an emetic, in the 
dose of 15 drops. 

In the form of the infusion, lobelia is useful as a lotion in the treat- 
ment of the dermatitis produced by poison-ivy. The proportion used 
should be an ounce to the pint of water. 

The preparations of the B. P. are the Tinctura Lobelias, dose 10 
minims to J drachm, and Tinctura Lobelias Mtherea, dose 10 to 30 
minims. 

LYOOPODIUM. 

Lycopodium, TJ. 8., is a pale yellow powder derived from Ly co- 
podium Clavatum, a species of moss. It is used by pharmacists as a 
powder in which to roll pills and by physicians and nurses to prevent 
the intertrigo or chapping of the skin of infants and adults. 



LYSOL. 

This is a preparation made by dissolving in fat and saponifying 
with alcohol that part of tar oil which boils between 190° and 200° 
C, and is a brownish, clear, oily fluid, smelling somewhat like crea- 
sote. It is used for the same purposes as creolin, but possesses the 
advantage of forming a clear, soapy fluid, when mixed with water, in 
which instruments can be seen. If small instruments are used the 
solution is too soapy, and renders them slippery. Those who have 
used lysol claim that it does not affect the operator's hands, except to 
render them soft and flexible. Experiment shows it to be possessed 
of marked antiseptic power, and it is far less poisonous than carbolic 
acid. Used upon mucous membranes the solution should not be 
stronger than 2 per cent. 

MAGNESIA. 

Magnesia is the oxide of magnesium made by exposing the carbonate 
of magnesium to a red heat. It is used in the form of the light 
magnesia (magnesia levis) as a dusting powder. The troches ( Trochisci 
Magnesias, TJ. 8.) each contain 3 grains. 

Magnesia is an antidote to arsenic, and when employed to precipi- 
tate a soluble preparation of iron it forms the antidotum arsenici (Fer- 
rum Oxidum Hydratum cum Magnesia, TJ. S.) 

It is important that the student should not confuse magnesia and 
magnesium. The first is the oxide of the second, and is sometimes 
called calcined magnesia, or ll Husband's Magnesia." Magnesia is of 
little value except as a feeble antacid. Magnesia and the carbonate of 
magnesium may be used interchangeably. 



228 DKUGS. 

MAGNESIUM. 

Magnesium is a metal never used as such, but always in the form of 
one of its salts, which are the sulphate, citrate, carbonate, and sulphite. 
The sulphite is a natural salt found in sea- water and in caves or in the 
water coming from the latter. The citrate and carbonate are derived 
from the sulphate. The carbonate is insoluble in water and alcohol. 
The others are soluble. 

Magnesium Carbonate. 

The Carbonate of Magnesium is official in the form of the heavy 
and light powder (Magnesii Carbonas Ponderosa, U. S. and B. P., and 
Magnesii Carbonas, V. S., Magnesii Carbonas Levis, B. P.). These two 
substances do not differ in respect to their effects. The light magnesium 
is never given internally, because of its bulk, but it is used as a dusting 
powder in intertrigo, and in the form of white cubes rubbed on the skin 
to prevent excessive perspiration and as a cosmetic. The heavy mag- 
nesium is used as an antacid, and is not, as has been thought by some, 
in any sense a laxative, as it possesses no such power. When the 
stomach or intestines contain much acid from fermatative changes, these 
acids may, however, unite with the magnesium and form a slightly 
laxative salt. 

In sick-headaches due to great gastric acidity, carbonate of magne- 
sium is often of service. The dose of the carbonate is from 5 to 60 
grains. It should not be used constantly, as there is danger that it 
will accumulate in the intestines. 

Liquor Magnesii Carbonatis, B. P., is given in the dose of 1 to 
2 ounces as a laxative. 

Magnesium Citrate. 

The Citrate of Magnesium (Magnesii Citras) is a much more irri- 
tating purge than the sulphate, but it is more agreeable to the taste. It 
is official in two forms, one of which is the solution (Liquor Mag- 
nesii Citratis, U. S. and B. P.), which is effervescent and should never 
be used unless freshly prepared. It is made by adding bicarbonate 
of potassium to a syrupy solution of the citrate of magnesium, con- 
taining an excess of acid, and corking the bottle tightly, the cork 
being tied down with a strong cord. Care should be taken that the 
bottle is a strong one. The dose is half to one bottle. It is too irri- 
tating to be used where inflammation of the alimentary canal exists, 
but is useful in the treatment of sick and bilious headache. 

The Granulated Citrate (Magnesii Citras Granulatus, U. S.) is less 
agreeable to take. It should be dissolved in water, about 1 to 3 
drachms of the salt being used in each dose, and swallowed while 
the solution is effervescing. It must be kept in bottles tightly 
corked. 

Magnesium Sulphate. 

Sulphate of Magnesium (Magnesii Sulphas, U. 8. and B. P.) is a 
white granular powder of neutral reaction, salty taste, and is soluble 



MANNA. 229 

in water. It is the form generally known by the laity as " salts/' 
although in some parts of the country this also includes the sulphate 
of sodium. According to the studies of Hay and others, sulphate of 
magnesium is a purge by reason of its abstraction of water from the 
intestinal bloodvessels. All strong saline solutions above the strength 
of 7 per 1000 abstract liquids from the tissues when brought in 
contact with them. On the other hand, if a saline solution be less 
strong than 7 per 1000, it will abstract salts from the tissues and 
replace them with water. The recollection of these facts readily makes 
clear the use of magnesium sulphate. .Whenever a thorough purga- 
tive action is required, that is, where depletion of the intestine or 
absorption of exudations is to be attained, the magnesium should be 
given in concentrated form, so as to make its solution of as high a 
percentage as possible. Magnesium sulphate may be given by enema 
with the double purpose of unloading the bowels and acting as a deple- 
tant. The best mixture for this purpose seems to be that proposed by 
Watkins, namely, 2 ounces of magnesium, 1 ounce of glycerin, and 4 
ounces of water. 

In cases of dropsy this is particularly necessary, and from one to 
two ounces should be given before breakfast, or on an empty stomach, 
in as little water as will dissolve the salt. (See Dropsy.) 

In enteritis and peritonitis this use of magnesium is widely recog- 
nized as a proper measure. The sulphate is not irritating and may be 
given freely when inflammation exists. (See Peritonitis.) It forms 
a large part of most of the natural purgative waters. The B. P. 
recognizes an enema, Enema Magnesii Sulphatis, composed of sulphate 
of magnesium 1 part, olive oil 1 part, starch mucilage 15 parts. 



MANGANESE. 

Manganum, or Manganese, is official in the form of the black 
oxide (Mangani Oxidum Nigrum, U. 8. and B. P.), and the sulphate 
(Mangani Sulphas, U. S.). The first of these, under the name bin- 
oxide of manganese, has been highly praised in amenorrhea de- 
pendent upon functional disturbance and anaemia. The dose is 3 to 
5 grains three times a day, in pill form, and the drug should be taken 
for a few days before the expected or proper date for menstruation. 
The sulphate is rarely if ever employed, but may be tried in malarial 
jaundice. The dose is 1 to 2 grains. 



MANNA. 

Manna, TJ. 8. and B. P., is the concrete juice of the exudation of 
Fraxinus Ornus, a tree of Europe. It occurs in small or large round- 
ish masses, looking somewhat like a gray-colored gum arabic. It has 
a sweet taste and odor. Sometimes the taste is a little bitter. 

Therapeutics. — Manna is the most feeble of the laxatives, and 



230 DRUGS. 

causes a slight flatulence in some persons. In children fed by the 
bottle one of the most frequent disorders is obstinate constipation, and 
for its relief 1 to 2 drachms of the sweet variety of manna may be 
dissolved in the milk of each bottle. When given to older children 
or adults manna is always combined with other more powerful drugs, 
chiefly to cover their taste. It may be combined with advantage with 
rhubarb and senna, and it enters into the official Infusum Sennas Com- 
positum, U. S., the dose of which is from 1 to 4 fluidounces. 



MATRICARIA. 

Matricaria, U. S., German Chamomile, consists in the flower-heads 
of Matricaria Chamomilla, a European plant, possessing mild tonic 
properties in moderate dose. In larger amounts it acts as au emetic 
and anthelmintic. In the form of an infusion, of the streugth of 1 to 
2 ounces to the pint, it has been largely used as a diaphoretic, and, in 
small doses, to prevent colic iu teething children. 



MENTHOL. 
(See Peppermint.) 

MERCURY. 

Hydrargyrum, U. S. and B. P., Mercury, or Quicksilver, is a 
heavy fluid metal of a peculiar color and appearance. As mercury 
it is used in medicine in the form of the ointment, the plaster, gray 
powder, and blue mass. 

Physiological Action. — When mercury is taken into the body in 
one of its insoluble and mild preparations, it may cause no evidence of 
its presence until by frequent dosage the system in general begins to 
feel its influence. The first evidences of this are to be found in the 
mouth, and consist in tenderness of the teeth when the jaws are firmly 
and quickly closed, foetid breath, sponginess of the gums, which finally 
may bleed at the slightest touch, swelling of the tongue, and, most 
prominent of all, excessive salivation, a condition sometimes called 
ptyalism. If the use of the drug is persisted in, all these symptoms 
grow worse. Eczema, and finally sloughs of the chin and chest de- 
velop as the result of the constant dribbling of saliva and the direct 
depressing effect of the drug on the tissues. The teeth drop out, the 
maxillary bones undergo necrosis, and amid a general melting-down 
and decomposition of the tissues the patient dies. The blood is aifected 
and becomes very thin, fluid, and poor in its corpuscular elements. 
These symptoms ensue on the use of mercury in continued doses, and 
rarely follow exposure to the drug in the processes of the arts. In the 
arts, as, for instance, in the making of looking-glasses, workmen are 






MERCURY. 231 

often affected by various trains of symptoms varying very widely in 
their course. In some cases the nervous system becomes chiefly affected. 
Tremors of all sorts arise, paralysis agitans is developed with its 
typical characteristics, and widely different changes and degenerations 
in the spinal cord ensue. Chorea often comes on in chronic mercurial 
poisoning, and its occurrence in an adult should cause inquiry as to any 
possible exposure to mercury. In other cases brownish discoloration 
of the skin, resembling Addison's disease, appears. Blindness, deaf- 
ness, sensory disturbances, such as hyperesthesia and ausesthesia, are 
developed, and localized wasting of muscles or groups of muscles may 
assert themselves. In still other cases the blood becomes impoverished 
and mercurial cachexia is developed. 

It is worthy of note that children under three years are rarely 
salivated by the use of mercury, but this is no reason for using this 
drug carelessly in this class of cases, since the other changes in the 
organism nevertheless occur. 

The question as to the form in which mercury finds entrance into 
the system is one of interest and importance. According to certain 
writers, it is changed into an albuminate and so circulates in the blood, 
but while this is probably true it is not known to be a fact. 

It is generally supposed that the bichloride is held in solution as 
an albuminate of the oxide of mercury united with sodium chloride, 
but others have asserted that metallic mercury in a state of minute 
subdivision circulates in the blood ; this point, however, cannot be 
considered settled, and the drug undoubtedly accumulates in all the 
tissues, more especially in the liver and kidneys. 

Mercury in all its forms is absorbed, and eliminated by the kidneys, 
liver, skin and salivary glands. No secretion of the body, even to the 
semen, fails to carry it out of the system, but it is to be remembered 
that, although all these parts are actively engaged in its elimination, 
the drug nevertheless rapidly accumulates in the body. "Wmternitz 
asserts that the drug is excreted with equal rapidity whether given in 
its soluble or insoluble forms, or, in other words, that calomel is 
absorbed and eliminated as rapidly as is corrosive sublimate. 

Balzer and Klumpke have made a long series of observations at the 
Lourcine Hospital, in Paris, on the rapidity of the elimination of 
mercury by the kidneys during a treatment of long standing. While 
there are many methods for the estimation of mercury in organic fluids, 
these investigators throughout adopted that of Witz, as modified by 
Souchow and Michaelowsky, which permits of the easy detection of 
the 10 1 00 of a grain in an ounce. After a single dose of mercury the 
elimination of the drug is rapid and sometimes complete in twenty- 
four hours, but if a continuous treatment is interrupted its excretion 
continues for some time, and Kussmaul and Gorup-Besanez have 
found it in the liver as much as a year after its administration has 
been stopped. The amount of mercury that can be readily eliminated 
for many weeks from the kidneys when the body is saturated is about 
Yg of a grain daily. 



232 DRUGS. 

Therapeutics. — The employment of mercury in medicine centres 
around four great points, viz. : 1st, its value in syphilis and kindred 
states; 2d, its use as a purge; 3d, its power as an antiseptic and 
germicide ; and 4th, its action as an antiphlogistic ; the first and fourth 
points are fulfilled by all the mercury salts more or less perfectly, the 
second only by blue mass and calomel, the third by the bichloride and 
biniodide of mercury. 

In syphilis mercury is to be given, not because the patient shows 
symptoms of the secondary or tertiary type of the disease, but because 
the conditions present do or do not call for its employment. Many 
writers have insisted that it ought only to be employed in the second- 
ary stages, and while this is, as a general rule, correct, certain con- 
ditions may call for it at any time. (See Syphilis.) 

Mercury is often administered by means of fumigations or inhala- 
tions both for the removal of local and general syphilitic disorders. 
The best apparatus for either purpose is one devised by Bumstead, 
and it is both simple and inexpensive. It consists of a sheet-iron cup 
so bent that the bottom of the vessel instead of being flat projects into 
the centre of the cup, thereby forming a raised centre with a little 
ditch about it. The top of this projection is flattened, and on its apex 
is placed the calomel which is to be sublimed. The surrounding ditch 
is then filled with hot water, and the cup placed over an alcohol flame 
which disengages the vapor of the calomel and water. 

When inhalations are used the face should be held some six or eight 
inches away from the cup to permit the fumes to pass through the air. 
Under these circumstances the quantity of calomel used should not 
exceed 4 or 5 grains at each sitting. 

If general fumigations are to be practised the patient places the 
lamp and cup with 30 grains of calomel on it under a chair on which 
he sits wrapped in a heavy blanket. 

When inhalations are used the mouth should be rinsed out to pre- 
vent mercurial stomatitis, unless a local action on the buccal mucous 
membrane is desired. Not more than eight or ten inspirations should 
be taken at one sitting. 

The employment of mercury as a purge or laxative having a special 
action on the liver is constantly resorted to. The two preparations 
used are blue mass and calomel, but the latter is more active. They 
both cause soft and watery stools, according to the dose in which they 
are given, but the blue mass is rarely, if ever, used, except for the 
production of a laxative effect. 

Much discussion has arisen as to whether mercury does affect the 
liver, and whether the peculiar greenish or brownish-yellow stools 
produced by it are due to the presence of bile or mercury. 

The experiments of Rutherford, Prevost and Binet, and others 
upon the lower animals seem to prove that in these instances, at least, 
mercury does not increase the biliary flow ; but, on the other hand, it 
is undoubtedly a fact that in man, even so small a dose as 2V of a 
grain of calomel may produce a bilious-looking passage, and yet it is 
evident that there cannot be enough mercury present to color a large 



MERCURY. 233 

passage green or yellow. Again, analysis of the stools often fails to 
find any mercury unless large doses are given. Further than this, 
we know clinically that when the stools are clay-like and lacking in 
biliary coloring-matter mercury will restore the normal state. The 
conclusion must be reached that, be the results in animals what they 
may, in man, at least, the drug does increase biliary secretion and 
flow. 

Calomel and blue mass are largely used in the condition known as 
biliousness, and undoubtedly give relief. (See Biliousness.) If the 
tongue is heavily coated, the breath foul, the conjunctiva a little icte- 
roid, and headache is present, either of them should be employed. In 
remittent malarial fever the use of small repeated doses of calomel will 
often bring relief from the vomiting, and it should always be given in 
the treatment of malarial disease before quinine is used, if a thorough 
action of the antiperiodic is required. 

The disinfectant and germicidal power of bichloride of mercury and 
of the biniodide are very well established by clinical experience and 
experimental investigation. The strength of the bichloride in solu- 
tion for antiseptic purposes may vary from 1 to 2000 to 1 to 20,000 
of water, and for disinfectant use from 1 to 500 to 1 to 1000. (See 
Antiseptics.) 

In using the bichloride of mercury as an antiseptic it is necessary to 
add a few grains of tartaric acid to the solution to prevent its uniting 
with the albumin of the tissues to form an insoluble and useless 
albuminate. The same is true of the mercury biniodide. 

The antiphlogistic or anti-inflammatory action of mercury is very 
marked indeed, but its employment is absolutely limited under these 
circumstances to one variety of inflammation, namely, the sthenic or 
dynamic form. In inflammation arising during the course of some 
exhausting disease mercury is not only contra-indicated, but harmful. 
Thus, if a man in health is stricken with pleurisy or peritonitis or 
meningitis, or any acute inflammation of a serous membrane, be the 
cause what it may, the exudate poured out will probably be fibrinous, 
and capable of undergoing organization, thereby causing adhesions of 
the pleural surfaces, of the intestines, or of the meninges of the brain. 
On the other hand, if a man be taken with pleurisy or meningitis 
during the course of phthisis or typhoid fever, the exudate will be 
serous and large in quantity. It is in the first case that mercury 
should be used, to prevent the fibrinous exudate or to make it serous. 
In the second instance it will do harm by increasing the exudation. 

When given as ah antiphlogistic the drug is often combined with 
opium to relieve the pain and irritation and to prevent purging. In 
meningitis arising from head injuries this is the routine treatment and 
may be carried out by the use of powders containing J grain of calomel 
and J grain of powdered opium every hour till 1 or 1 J grains of each 
are taken. The simultaneous use of the ice-bag to the head and perfect 
quiet will often bring relief very rapidly. 

Mercury is also the best remedy in sthenic endocarditis, and should 
be given in full dose. The bichloride may be used in small doses in 



234 DRUGS. 

place of the calomel, and does not, of course, produce the same ten- 
dency to laxity of the bowels. At the same time it often seems to be 
less efficacious. 

Mercury in myocarditis and pericarditis is also of service, and 
certainly exerts distinct prophylactic power in the early stages of 
diphtheria and membranous croup. (See Diphtheria.) 

Leaving the general subject of mercury, we may now consider each 
individual preparation. 

Ammoniated Mercury. 

White Precipitate or Ammoniated Mercury [Hydrargyrum Ammonia- 
turn, U. S. and B. P.) is used in an ointment ( TJnguentum Hydrargyri 
Ammoniati, U. S. and B. P.) in various skin affections. It should 
generally be diluted with lard. 

In ozcena, whether syphilitic or not, Trousseau has recommended 
the employment of the following powder as a snuff: 

R. — Hydrargyri ammoniati . . ' . . . gr. iv. 

Pulv. sacchar. alb. §ss. M. 

S. — To be used as a snuff, after thoroughly blowing the nose. 

The Red Precipitate may be used instead of the white. This treat- 
ment removes the stench and may cure the complaint. It may, however, 
irritate the mucous membrane, in which case it should be used in the 
strength of 2 grains to the J ounce. It is never used internally. 



Bichloride of Mercury. 

The Bichloride of Mercury, or Corrosive Sublimate [Hydrargyrum 
Chloridum Corrosivum, U. 8., Hydrargyri Berchloridum, B. P.) as it is 
called, is an exceedingly poisouous and irritating substance when taken 
in concentrated form. 

Taken internally, it causes violent pain in the stomach, vomiting, 
purging of mucus, blood, and the contents of the intestine, collapse, 
syncope, and death. If taken in poisonous amount the patient should 
be made to swallow large amounts of the antidote, white of egg, the 
stomach should be washed out with the stomach-pump, heat should be 
applied about the body, and the proper stimulants be given if the 
pulse or respiration fail. If death does not occur at once the patient 
generally has a protracted convalescence or else dies from the organic 
changes produced in the gastro-intestinal tract, such as strictures, 
sloughs, destruction of the peptic glands and ulcerations. 

The bichloride of mercury is an exceedingly useful preparation of 
mercury for hypodermic injection in syphilis and is better than 
calomel for this purpose. About j-j grain may be injected deeply and 
gently into the cellular tissues every two or three days. When the 
injections are made the greatest possible cleanliness should be obtained. 
The needle should be aseptic and the hands of the operator well dis- 



MERCURY. 235 

infected. The best place for the injection is in the gluteal region or 
between the shoulder-blades. 

Mercury bichloride, aside from its antiseptic use (see Antiseptics), 
is of great value when given internally, not only in syphilis, but in 
other states not associated with any such depraved condition. In 
diphtheria it may be used to prevent fibrinous exudation as readily as 
calomel (see Diphtheria), and in tonsillitis, where the inflammation is 
severe, it is often used with great service. 

When using a solution of bichloride of mercury as an antiseptic, 
tartaric acid should be added to the solution to prevent the precipita- 
tion of the mercury in the form of an albuminate. 

In small amounts, that is in -^ to ^ of a grain three times a day, 
the bichloride is one of the best remedies which we possess for the 
treatment of anosmia, be its cause what it may. 

Bichloride of mercury is of value in minute doses of 5-^- to -^ of 
a grain in the ill-smelling green stools of summer diarrhoeas in adults 
and children, and it has been recommended that a solution be made 
of \ a grain in 5 ounces of water and a teaspoon ful given every hour 
until relief is obtained. The water used in making the solution 
should be distilled, and it may be well to add to it a little tartaric acid 
to prevent precipitation of the bichloride by organic matter which 
may have gotten into the water. This treatment is particularly useful 
in mucous diarrhoea,in which blood and mucus are thoroughly mixed. 
Patients in the dispensaries often speak of these passages as contain- 
ing " corruption," and others think they consist of " lumps of flesh," 
owing to the masses of blood and mucus. Whether the disease be 
acute or chronic, the bichloride, used in the way just described, will be 
found of service. In dysentery and the diarrhoea of adults the same 
treatment may be resorted to, using two teaspoonfuls of the solution 
instead of one. It is hardly necessary to add that the greatest care 
must be bestowed upon the diet and clothing. The author has treated 
a child suffering from persistent diarrhcea for months with varying 
success, only to succeed when, it being found that the abdomen was 
exposed to the air, the mother was forced to apply and keep on the 
child a flannel binder. 

In some cases in which an obstinate syphiloderm is present, half an 
ounce of corrosive sublimate and one ounce of chloride of ammonium 
may be added to a warm bath which should be taken every few days. 

Half a grain of the bichloride of mercury in six ounces of water 
is said to be most efficient as an injection in gleet, if used every three 
or four hours. (See Gonorrhoea.) 

In all parasitic affections of the skin a solution of 2 grains of 
bichloride to the ounce of water may be sopped on the part three times 
a day. A solution of perchloride of mercury (Liquor Hydrargyri 
Perchloridi) is official in the B. P. ; it is prepared by adding \ grain 
of the perchloride of mercury to 1 ounce of water, with J grain of 
ammonium chloride to hold it in solution. (For the antiseptic uses of 
the bichloride of mercury, see Antiseptics and Disinfectants.) 



236 DRUGS. 

Biniodide of Mercury. 

Mercury Biniodide {Hydrargyri Iodidum Rubrum, U. S. and B. P.) 
is a bright-red powder, possessing irritating powers equal to or above 
those of the bichloride, and causing symptoms when taken in over- 
dose closely resembling those produced by the latter drug. Owing to 
the formation of the salt it is thought to be particularly useful in the 
later stages of syphilis. The dose is -^ to -^ of a grain. (See Syphilis.) 
An ointment ( TJnguentum Hydrargyi Iodidi Rubri, B. P.) is useful as 
an application in goitre and obstinate skin diseases. 

At one time it was thought that biniodide of mercury was a better 
antiseptic than the bichloride, but recent researches have proved that 
this is not a fact. 

Black Wash. 

Black Wash (Lotio Hydrargyri Nigra, B. P.) is made by adding 
1 drachm of calomel to a pint of lime-water. It is used for wash- 
ing syphilitic sores and wounds, and in various forms of eczema. 

Blue Mass. 

Blue Mass (Massa Hydrargyri, U. S., Pilula Hydrargyri, B. P.) 
is made by rubbing up metallic mercury with liquorice and other 
excipients, and is often called Blue Pill. Each grain of the mass 
contains J grain of mercury, and it may be given in the dose of 
from J to 20 grains, for the same laxative purposes for which we use 
calomel. Blue Mass is rarely used to produce systemic effects. 

Calomel. 

Calomel Hydrargyri Chloridum Mite, U. S., Hydrargyri Subchlor- 
idum, B. P.), or the Mild Chloride of Mercury, is an insoluble salt 
which is nevertheless freely absorbed. Some have taught that it enters 
into the body as a bichloride, being changed into this salt by the acid 
of the stomach, but practically this does not occur. Calomel on pass- 
ing into the intestines is changed by the alkaline juices there present 
into the black or gray oxide of mercury. 

Calomel when used as a laxative purge should be given in the dose 
of ^ to j- grain every half-hour or every fifteen minutes until 1 or 2 
grains are taken, as it will act as efficiently in this way as if 10 grains 
are given at one dose, and there is no danger of producing ptyalism. 
The reason that small doses are as efficient as large ones lies in the 
fact, that only the calomel which is changed into the gray oxide is 
active, and as the amount of alkaline juice in the intestine is small, 
only a minor part of a large dose of calomel acts, the major portion 
escaping unchanged. This is the reason that bicarbonate of sodium 
is added to calomel powders, to aid the intestinal juice in the reduc- 
tion of the salt. If purgation does not occur after a dose of calomel, 
a saline purge may be given at the end of twenty-four hours, and this 



MERCURY. 237 

must always be used if large doses of the mercurial are employed, to 
avoid possible mecurialization. 

Mercury in the form of calomel is very largely used hypodermically, 
being held in solution by a mucilage, or better still by fluid cosmoline. 
Best of all, however, is the employment of chloride of sodium iu water 
with the calomel in the proportion of 5 parts each to 50 parts of water. 
It should be injected deeply into the tissues, not immediately underneath 
the skin, the greatest cleanliness being necessary to avoid abscesses. 
The best place for these injections is in the fold of the buttocks, but 
sloughing, tetanus, and even gangrene, has followed its employment 
in this way. (See Salicylate of Mercury.) 

In dysentery of the acute form calomel and ipecac are the two best 
remedies. (See Dysentery and Ipecac.) The calomel should be given 
in small doses repeated every hour or half-hour until a favorable change 
in the number and character of the stools appears. Calomel is not to 
be used if great asthenia complicates the disease. 

In children who seem constantly " under the weather " and never 
quite well, who have flatulence, foetid breath and ill-smelling, pasty 
stools, calomel often gives great relief in the dose of -^ of a grain every 
half-hour until four doses are taken, this treatment being pursued 
every fourth or fifth morning. 

In jaundice due to exposure to cold and to slight hepatic congestion 
| of a grain of calomel every half-hour until J grain is taken will 
often bring relief. 

Calomel is generally prescribed in conjunction with sugar of milk, 
white sugar, or bicarbonate of sodium, which are added to increase 
the bulk and wieldiness of the powder, and, in the case of the latter 
ingredient, to increase its activity. Owing to its lack of taste, calo- 
mel is often placed on the tongue in children, but in this instance 
white sugar is to be used, in small quantity, as the other vehicles are 
less agreeable. The most agreeable form of administration is in tritu- 
rates. 

It is important to remember that calomel, when used as an anti- 
syphilitic, produces salivation very much earlier than the other mer- 
curials. 

A very important use of calomel, and one which has been brought 
forward very recently as new, but which is really many years old, is 
its employment in dropsy as a diuretic, either alone or combined with 
squills or digitalis, or with opium to prevent purging. The dose is 
small, about 1 grain thrice a day, and if a diuretic influence does not 
assert itself in twenty-four hours it should not be continued. Still 
another use of calomel is in typhoid fever, in which disease it has been 
highly recommended in small repeated doses, particularly if constipa- 
tion is present. In the opinion of the author this is disadvantageous 
as a routine measure and entirely uncalled-for. 

Sydney Ringer has called attention to the fact that in constipation 
or in "biliousness" podophyllin does more good than calomel pro- 
vided that the stools are dark in color, whereas if the same signs are 
present but the stools light and clayey in color calomel is more efn- 



238 DRUGS. 

cient. The author has proved the correctness of this assertion so 
frequently that he is convinced of its truth. 

Calomel has been recommended in the condition of anorexia and 
depression following acute diseases, and, when the tongue is covered 
by a thick yellow coat, it is the remedy for the gastro-intestinal torpor 
always present. While purgative doses of calomel certainly are of 
value, the use of freshly prepared nitro-muriatic acid is, however, 
highly preferable to the mercurial salt in many such instances. 

Calomel is often given in small doses to " settle the stomach." 
Sometimes it will act in this way, but in other cases it will seem to 
increase the nausea and bring on vomiting. This is true of both 
adults and children, and it is impossible to tell beforehand which will 
occur. In a peculiar form of vomiting occurring in very young chil- 
dren, which comes on immediately after the food is swallowed, the 
rejection of milk being forcible and perhaps so sudden that it is not 
even curdled, and which is not accompanied by much straining, calomel 
will often give relief when all other remedies fail. It should not be 
resorted to until some evidences of wasting occur, as this action of the 
stomach in many children only rids that organ of that part of the milk 
which is in excess, and is a purely physiological regurgitation. The 
calomel may be given in the dose of y 1 ^ of a grain every hour, or, if 
preferred, gray powder in the dose of J of a grain every hour for 3 
doses is equally efficient in these cases. 

Calomel will often remove syphilitic condylomata if dusted over them 
for some time, and an ointment made of one drachm of calomel to one 
ounce of lard is very useful in pruritus. 

Calomel ointment ( Unguentum Hydrargyri Subchloridi, B. P.) is 
often useful in the treatment of small patches of eczema, or the follow- 
ing prescription may be given for its use : 

R. — Hjdrarg. chlor. mit gr. xl. 

Magnesia? carbonatis . . . . gr. xl. 

Unguent, aquse rosse ^j. M. 

Mercury with Chalk. 

Mercury with Chalk {Hydrargyrum cum Greta, U. 8. and B. P.), or 
Gray Powder, is slightly purgative, but is chiefly employed in the 
treatment of infantile syphilis, as it will not freely purge. It is com- 
posed of 38 parts of mercury, 12 parts of sugar of milk and 50 parts 
of prepared chalk. The dose is 1 to 10 grains. Children suffering 
from syphilitic marasmus seem fairly to fatten on it. This prepara- 
tion is also of service in adults, and may be employed whenever the 
laxative effect of mercury is not desired. 

In the treatment of infantile diarrhoea with watery, colorless stools 
containing undigested food, gray powder in small doses is often very 
useful. 

Mercury Ointment. 

The Ointment of Mercury, Mercurial Ointment ( Unguentum Hy- 
drargyri, U. S. and B. P.), sometimes called Blue Ointment, is made 



MERCURY. 239 

by rubbing up mercury with suet and lard until it is extinguished — 
or, in other words, until the globules of mercury cannot be seen with 
a magnifying power of 10 diameters. 

The ointment of mercury is used externally in certain skin affec- 
tions, and for the purpose of influencing the general system in cases 
where the drug cannot well be taken by the mouth. In syphilis where 
a mercurial effect is to be reached, the ointment in small amounts 
should be thoroughly rubbed into the skin in various parts of the body, 
one evening in the left groin, the next in the right groin, the next 
evening in the left axilla and the fourth evening in the right axilla, 
beginning on the fifth evening in the left groin once more. This avoids 
local irritation of the skin by means of too frequent applications, places 
the drug on spots where it is readily absorbed, and very rapidly in- 
fluences the system of the patient. In infantile syphilis this method 
may be employed, or a flannel binder covered with the ointment may 
be placed about the belly. The clothes should not be changed too fre- 
quently, as their saturation with the drug aids in producing the im- 
pression upon the system, and the wearing of an undershirt saturated 
with the ointment after a few days' wear, is a very valuable, though 
somewhat dirty, method of producing mercurialization. The ointment 
of mercury is sometimes rubbed into the skin over enlarged glands. 
Under the name of oleate of mercury (Oleatum Hydrargyria U. S. and 
B. P.) a very efficient and more agreeable application than the oiut- 
ment, is used in the same manner, or still further diluted with lard. 
It is made from the yellow oxide of mercury. (See Oxides of Mercury.) 

For pediculus pubis, or in any case where parasites, such as the flea or 
louse, infest the region of the genitals, or any spot covered by a hairy 
growth, mercurial ointment may be used as a remedy owing to its lethal 
influence over these troublesome pests. Care should be taken that it 
does not cause salivation of the patient, and it must not be allowed to 
remain on the parts, but be wiped off in the course of an hour or two, 
or less. The following words from the pen of Dr. Joseph Leidy are 
sufficiently interesting to demand a place at this juncture : " We may 
here say that if it is once understood that all insects, including lice, 
are destroyed quickly by the application of any fixed or volatile oil, 
physicians will see there is no necessity of employing remedies of a 
noxious character to the patient. The fat of mercurial ointment is 
probably more active than the mercurial oxide." 

Mercurial suppositories (Suppositoria, Hydrargyri, B. P.) are used 
when a mercurial effect is desired without the danger of interfering 
with the digestion. 

Linimentum Hydrargyria B. P., and Emplastrum Hydrargyria 
U. S. and B. P., are used for the same purposes as is the ointment 
of mercury. The plaster is made with olive oil, resin and lead plas- 
ter instead of ordinary suet or lard. 

Nitrate of Mercury. 

The Solution of Mercuric Nitrate (Liquor Hydrargyri Nitratis, U. S. 
and B. P.), acid nitrate of mercury, is an exceedingly active, pene- 



240 DRUGS. 

tratiug caustic, so rapid in its effects that it seems to drop through the 
tissues. It may be employed for the removal of epitheliomata and large 
warts, and should be applied by means of a glass rod. This treatment 
may also be resorted to with advantage in lupus until the surface of 
the growth is level with the skin. The surrounding parts should be 
protected by lard or oil. 

As this treatment is very painful, the spot should afterward be 
covered with flexible collodion. 

Citrine Ointment ( Unguentum Hydrargyri Nitratis, U. 8. and B. P.) 
is used in chronic skin diseases of the scalp and trunk. It is too 
strong for ordinary use and should be diluted one-half or less with 
lard according to the stimulating effect required ; the dilute oint- 
ment is official in the B. P. as Unguentum Hydrargyri Nitratis 
Dilutum. 

» Oxides of Mercury. 

The yellow and red Oxide of Mercury {Hydrargyri Oxidum Flavum, 
U. 8. and B. P., and Hydrargyri Oxidum Rubrum, U 8. and B. P.), 
red precipitate, are used largely as a dressing for syphilitic sores when 
diluted about one-half with chalk or other powder. If used pure 
they are somewhat caustic. From the yellow oxide is made the Oleate 
of Mercury ( Oleatum Hydrargyri, U. 8. and B. P.), which is used for 
the same purpose as ordinary mercurial ointment. 

In intestinal and gasti'ic indigestion, with foul belching and very ill- 
smelling stools which are due to intestinal sepsis, the yellow oxide is 
sometimes given in the dose of -g 1 ^- to fa of a grain in trituration. 

Red Precipitate Ointment (Unguentum Hydrargyri Oxidi Rub?-i, 

V, 8. and B. P.) and the Ointment of the Yellow Oxide (Unguentum 

Hydrargyri Oxidi Flam, U S.) are largely used, diluted one-half with 

lard in chronic, scaly skin affections, in obstinate conjunctivitis and in 

granular lids. (See Styes.) 



Protiodide of Mercury. 

Mercury Protiodide (Hydrargyri Iodidum Viride, U. 8.) is much 
more mild than the biniodide and is given for exactly the same pur- 
poses. The dose is ^ to J of a grain three times a day. (See Syphilis 
for method of administration.) 



Yellow Sulphate of Mercury. 

Hydrargyri Subsulphas Clavus, U. 8., has been used under the 
name of Turpeth Mineral as an errhine in chronic ophthalmia, and 
also as a prompt emetic in croup. It is a quick and certain emetic, 
and, it is claimed, does not produce depression, but the writer would 
recommend great care in its use. The dose for a two-year-old child 
is 2 to 5 grains repeated in fifteen minutes if necessary. 



METHYLENE CHLORIDE. 241 



Yellow Wash. 



Yellow Wash (Lotto Hydrargyri Flava, B. P.) is made by adding 
30 grains of corrosive sublimate to a pint of lime-water. It is used 
for the same purposes as the black wash, but is much more stimu- 
lating. 

Incompatibles. — Bichloride of mercury should never be given wdth 
any other substance except iodide of potassium and chloride of am- 
monium, as it is incompatible with almost every other drug. With 
the iodide of potassium it may be used because the precipitate formed 
is at once re-dissolved, and the resulting mixture is highly alterative. 

Calomel should never be given with iodides or bromides, and hy- 
drochloric acid may convert it into the bichloride if the acid is present 
in any amount. 

One of the best ways to employ any of the various forms of mercury 
is in the form of triturates which may be prepared by triturating 10 
parts of the drug with 90 parts of milk sugar. The minute subdi- 
vision of the medicament aids in its efficiency because of its more 
ready absorption. 

METHYL CHLORIDE. 

Methyl Chloride is a colorless gas, easily liquefied under pressure, 
with an odor resembling that of ether and chloroform, used to produce 
local anaesthesia, which it does by absorbing a large amount of heat 
on passing from the liquid to the volatile state. It is usually kept in 
a siphon or in an ordinary bottle and applied to the skin in a spray, 
or better still, by means of a cotton tampon which is laid upon the 
skin and then saturated by the spray. 

Under these circumstances the skin becomes pale in a few seconds, 
and afterward perfectly white and parchment-like in appearance. 
Local anaesthesia is now complete, and minor surgical operations, such 
as opening boils or abscesses, can be performed without pain. The 
spray should not be continued more than 2 to 4 minutes, as local 
death of the tissues may result A great advantage of methyl over 
the spray of ether is its slight inflammability and rapidity of action. 
Methyl chloride is to be distinctly separated from methylene chloride. 
The first is monochlormethane, the second dichlormethane. 



METHYLENE CHLORIDE. 

Methylene chloride is made from chloroform or by the action of 
chlorine on marsh gas, and is a colorless liquid resembling chloroform 
in odor. It is readily decomposed by light, which process may be 
hindered by the addition of a little absolute alcohol. 

16 



242 DRUGS. 

Therapeutics. — It is employed as an anaesthetic in a manner like 
chloroform and was introduced as a safe substitute for that drug, but it 
is of doubtful safety and is little used. It has been used as a spray for 
the production of local anaesthesia. As stated under Methyl Chloride, 
it is not to be confounded with that drug. In England under the 
name of methylene chloride or methylene, a mixture of ethyl ether and 
and methylene chloride has been widely employed. This prepara- 
tion is, of course, to be distinguished from true methylene chloride. 
The amount of this mixture used to produce anaesthesia is 1 to 2 
drachms for minor and 3 to 6 drachms for major operations. The 
term methylene chloride has also been applied to a mixture of chloro- 
form and methyl chloride. 



MEZEREUM. 

Mezereum, U. S., Mezerei Cortex, B. P., is the bark of Daphne 
Mezereum, a plant of Asia, Europe, and Great Britain. It is sup- 
posed by some to be possessed of extraordinary alterative power, but 
this is certainly a mistake, as its influence in this line is very feeble. 
It is never used internally except in compound decoction of sarsa- 
parilla. It is distinctly irritant, and in overdose causes all the symp- 
toms of gastro-enteritis. Mezereum is so irritant as to have been 
used externally as a counter-irritant in the form of the ointment 
(TJnguentum Mezerei). It enters into the compound syrup, fluid ex- 
tract, and decoction of sarsaparilla. The official preparations of meze- 
reum are the extract (Extractum Mezerei, U. S.), the fluid extract 
(Extraetum Mezerei Fluidum, U. $.), and the ethereal extract (Ex- 
tr actum Mezerei jEihereum, B. P.), all of which are used as external 
irritants. 

MUSK. 

Musk (Moschus, U. S. and B. P.) is obtained from the preputial 
follicles of the musk deer of Thibet, and is a substance possessing 
the most remarkable penetrating powers, so far as odor is concerned. 
Very little of the musk for sale in the shops is pure, and most of it 
is not musk at all. Its price varies very greatly, but if sold for less 
than twenty-five cents a grain it is probably worthless or impure. 

Therapeutics. — For some unknown reason musk acts as a diffusible 
stimulant and supports the system. It is also an anti-spasmodic and 
nervous sedative. In all low fevers where the strength of the patient 
is fast ebbing away, and the nervous symptoms are those of the most 
advanced depression, rectal injections of musk in starch-water should 
be employed. The dose should be 5 to 10 grains. This drug is of 
value, either where nervous excitement or nervous collapse is present, 
but is not to be employed until it is absolutely needed to carry the 
patient past a crisis. If frequently employed it loses its power and 
the expense is a needless one. 



MYRRH. 243 

Musk is one of the best remedies in obstinate hiccough. The dose 
of the tincture (Tinctura Moschi, U. S.) is 30 drops to 1 drachm, and of 
musk itself 5 to 10 grains. 

MUSTARD. 

Mustard is official in the form of Sinapis Alba, U. S., Sinapis 
Albce Semina, B. P., or white mustard, aud Sinapis Nigra, 17. S., and 
Sinapis Nigrce Semina, B. P., or black mustard. Botli of these con- 
tain an irritant oil (Oleum Sinapis Volatile, U. S., Oleum Sinapis, 
B. P.) as their chief active constituent. 

Therapeutics. — Mustard is often used in the form of mustard flour 
as an emetic, when stirred up in water in the proportion of a table- 
spoonful to a glass of water. It is also employed as a counter-irritant 
and as a condiment. If given in excessive dose it will cause violent 
gastritis, and chronic gastritis is often set up by its constant use. It 
is contra-indicated internally duriug the existence of acute gastritis 
and all similar states. 

When used as a counter-irritant it is applied to relieve the pain of 
colic due to flatulence and acute inflammation, in muscular rheumatism 
and inflamed joints, and for neuralgia, and it may be applied at the nape 
of the neck in cases of headache and cerebral congestion. When applied 
to the skin of an ordinary individual it will produce a bad burn if left 
on more than a few minutes, and it should be mixed with wheat flour 
in the proportion of half-and-half for tender skins. Children generally 
will not stand more than one-fourth mustard. The plaster should be 
made with warm water or vinegar, or a little brandy may be used. 
Mustard plaster (Cataplasma Sinapis) is official in the B. P. 

The scald or burn produced by mustard is peculiar in its slowness 
to heal, and in the fact that it is tender and reddened for days. If 
the burning of the mustard becomes excessive it should be treated by 
a piece of lint soaked in lime-water and olive oil, half-and-half, or 
olive oil alone may be used. 

The oil of mustard is very irritant, and almost epispastic in its effects. 
It is given in the treatment of the atonic stomach of drunkards in the 
dose of J to J a drop. Charta Sinapis, U. S. and B. P., or mustard 
papers, are sometimes called sinapisma, and these afford a ready means 
of applying this counter-irritant. They are generally very strong, and 
should be covered by one or two layers of old and moistened linen to 
prevent too great an action. (See Counter-irritation.) The compound 
liniment (Linimentum Sinapis Compositum, U. S. and B. P.) is com- 
posed of the oil of mustard, castor oil, extract of mezereum, and 
alcohol. 

MYRRH. 

Myrrha, U. S. and B. P., is a gum resin obtained from Balsamo- 
dendron Myrrha, a tree of Arabia. It occurs in dark -colored tears, 
and contains an active principle, myrrhin. 



244 DKUGS. 

Therapeutics. — Myrrh, in medicinal amount, is a stimulant to the 
circulation and to the uterine and the bronchial mucous membranes. 

In amenorrhea due to functional inactivity, or anosmia, " iron and 
myrrh " is a standard remedy. 

The tincture of myrrh, diluted one-half, is useful in ulcerated sore- 
throat as a gargle, and the pure tincture is sometimes applied with a 
small brush or by the eud of the finger, to spongy or tender gums. 

In leuGorrhoea depending upon uterine trouble, and in chronic 
crystitis, myrrh is often of service. Sometimes it enters into expecto- 
rant mixtures given in the later stages of bronchitis. The dose of the 
tincture {Tinctura Myrrhce, TJ. 8. and B. P.) is 10 to 30 drops. It 
also enters into the composition of Pikdce Aloes et Myrrhce, TJ. 8. and 
B. P., dose 2 to 5 pills, and Tinctura Aloes et Myrrhce, TJ. 8. and 
B. P., the dose of which is 1 to 2 fluidrachms. 



NAPHTHALIN, or NAPHTALENE. 

Naphthaliu is a coal-tar derivative occurring in colorless mica-like 
crystals, possessing a peculiar smell, and soluble in alcohol to some 
slight extent. Helbing states that naphthalin when pure is colorless 
and without action on moist litmus paper. It should also dissolve in 
concentrated sulphuric acid without color when gently warmed. After 
it is taken for some time, or even after the first dose, the patient will 
state that when he belches, the gas has the smell and taste of burning 
rubber. 

The drug possesses distinct antiseptic power, and for this reason 
has been employed in certain gastric and intestinal diseases, associated 
with fermentative changes or dependent upon ulceration and organic 
lesions. In foetid diarrhoea it may be given as a deodorant and cure. 

When given to children, as in summer diarrhoea, the dose should be 
-J- to J grain every 2 or 4 hours, but adults may take as much as 5 to 
10 grains. More than this will disorder the stomach. The drug 
should be given in powder, in capsules, or with sugar. It has not 
been as widely employed as was expected when it first came before the 
profession, and certainly often fails to do good. 

In cats aod rabbits naphthalin when administered continuously for 
a considerable period of time may produce cataract. 



NITRATE OF POTASSIUM. 

Nitre (Potassii Nitras, TJ. 8. and B. P.), or Saltpetre, occurs in 
long needle-like crystals, and has a sharp, saline taste. Sal Prunella 
is saltpetre melted and run into moulds. 

Next to the chlorate of potassium this is the most poisonous of the 
potassium salts, and produces when taken in overdose violent symp- 
toms of gastro-enteritis. While it does not affect the blood, it is more 
irritant than the chlorate. 



NITKATE OF SILVER. 245 

Nitrate of potassium is rarely employed at present, and has been 
very properly put aside as inferior to the harmless vegetable potas- 
sium salts (the citrate, acetate, and bitartrate). If used in rheumatism 
the dose should be 1 ounce in a pint of barley-water or syrup of acacia 
and water, to be taken in divided doses of a tablespoonful every three 
hours. Nitrate of potassium papers (Oharta Potassii Nitratis, U. 8.) 
are made by dipping unsized paper in a solution of the drug of the 
strength of 20 parts of the salt to 80 parts of distilled water. They 
are rolled into cigarettes and smoked by asthmatics or burned in a pan 
and the fumes arising from them inhaled. 

J. Solis-Cohen thinks that asthmatics are more benefited by smoking 
nitrate of potassium papers than by any other remedy. The paper 
should be medium thin bibulous paper. If too thick it gives off too 
much heat and gas, if too thin it does not hold enough of the drug. 



NITRATE OP SILVER. 

Nitrate of Silver {Argenti Nitras, U. S. and B. P.) is a heavy, crys- 
talline salt of silver, readily soluble in its own weight of water. 

It is official as the pure nitrate {Argenti Nitras, U. S. and B. P.) 
and as the sticks or fused rolls {Argenti Nitras Fusus, U. S.) or lunar 
caustic. The latter are never used in medicine internally, only the 
crystals being employed. Applied to the tissues of the body or other 
substances it causes a brown and finally a black stain, which is due to 
the formation of an oxide of silver. 

Physiological Action. — Nitrate of silver is one of the few astringent 
substances which are applicable to inflamed mucous membranes, as it 
is, with lead, bismuth, and zinc, the only drug of the class which is not 
irritant as well as astringent. Locally applied it acts in pure form as 
a powerful caustic, which is, however, very superficial indeed, as the 
drug coagulates the albumin with which it comes in contact and thereby 
forms a coat which protects the tissues beneath. 

The action of the drug upon the circulation, respiration, and similar 
vital functions is only partly known and has no relation to its employ- 
ment in medicine. 

Nitrate of silver is eliminated from the system very slowly indeed. 

Poisoning'. — Almost immediately after the ingestion of a poisonous 
dose of nitrate of silver, violent pain in the belly, with vomiting and 
purging, comes on. At the same time evidences of widespread gastro- 
enteritis develop. The abdominal walls are knotted and hard, and 
perhaps scaphoid. The face is anxious and livid and covered with a 
sweat. When the vomiting occurs, the ejecta are seen to be brown or 
blackish or even white and curdy. The lips are stained white, then 
brown, then black. In some cases the nervous symptoms are severe 
and convulsions with delirium may occur. The convulsions are epi- 
leptiform. Death ensues either from gastro-enteritis or from centric 
respiratory failure accompanied by a profuse exudation of liquid mucus 
into the bronchial tubes. 



246 DRUGS. 

The treatment eonsists in the use of common salt, which is the 
chemical antidote, the employment of opium and oils to allay irrita- 
tion, and in the ingestion of large draughts of milk and of soap and 
water for the purpose of diluting the poison and protecting the mucous 
membranes of the oesophagus and stomach from the action of the 
irritant. The bodily heat must be maintained. 

Chronic Poisoning. — This is a form of poisoning quite frequently 
seen. The most prominent symptom is the pale slate-blue color of 
the skin which causes the individual to be most livid and death-like 
in appearance. 

Argyria, as chronic silver poisoning is called, is caused by the con- 
tinued employment of the drug until it is deposited in the tissues. 
It is then found in every part of the body. The first signs of dis- 
coloration can generally be seen in a darkening of the conjunctiva over 
the sclerotic coat of the eye, or in a dark line on the inner part of 
the lips. 

The treatment of argyria is not hopeful so far as the color of the 
skin is concerned, but it may be improved by the use of iodide of 
potassium to aid in the elimination of the poison. 

Therapeutics. — Internally this salt is used as a cure for gastric 
ulcer, and it is certainly the best remedy we possess if combined with 
extract of hyoscyamus or opium in pill form. In chronic gastric 
catarrh and gastritis nitrate of silver is very useful, when the patient 
is troubled with sour eructations or when vomiting occurs after meals. 
When used in these states it should be given in J to \ grain doses, half 
to one hour before each meal, in order that the stomach may be ex- 
posed to its effects and not be protected by food. 

In intestinal ulceration the drug has been highly recommended by 
Dr. Pepper, and under these circumstances should be given in hard or 
keratin-coated pills in order that it may escape through the stomach 
without being chemically changed. In ulceration of the cmcum and 
rectum and in acute and chronic dysentery the disease should be attacked 
by injections of nitrate of silver. If the caecum is involved the solu- 
tion must be in large quantity in order to reach the part affected, but 
if the rectum is diseased the amount of liquid injected should not ex- 
ceed four ounces, the bowel in either case being washed out before- 
hand by warm water to rid it of faeces. Soap and water and salt and 
water must not be used for this purpose, as the soap which remains in 
the bowel will prevent the silver salt from acting. The strength of the 
solution employed shouid be 1 drachm to three pints of water in csecal 
trouble, and 3 grains to each four ounces in rectal trouble. If the 
latter condition is very obstinate and chronic, the strength may be 
raised to 5 grains to each four ounces. 

Whenever nitrate of silver injections are used in this way a solution 
of salt and water should be made, ready for use, and injected if the 
action is too severe, or as soon as it is thought that the drug has acted 
with sufficient thoroughness. 

Nitrate of silver is the only remedy of any value in idiopathic ante- 
rior and posterior spinal sclerosis, but often fails. 



NITRATE OF SILVER. 247 

Nitrate of silver has been largely used in epilepsy and chorea, but is 
now seldom so employed, and does little good in most cases. 

Dr. William Pepper speaks highly of the continual administration 
of nitrate of silver in pill form in the dose of \ to J grain through the 
entire attack of typhoid fever, and believes it greatly modifies the severity 
of the disease. 

Externally nitrate of silver is used for many purposes, and will often 
prevent the pitting of smallpox, if on the fourth or fifth day the vesi- 
cles are punctured by a needle dipped in a solution of nitrate of silver 
in the strength of 20 grains to the ounce of water. Others simply 
paint the skin over the eruption with a solution of 5 to 10 grains to 
the ounce, claiming that this method is equally effective and prevents 
inflammation and suppuration. 

Higginbottom has highly recommended the use of nitrate of silver 
over erysipelatous inflammations, but the practice is not often resorted 
to, and is now supplanted by better measures. (See Erysipelas.) In 
other inflammations of a superficial character nitrate of silver is of great 
value. Painted in strong solution over the scrotum in the early stages 
of orchitis or epididymitis it will often relieve the pain and swelling, 
and felons can sometimes be aborted by its early application over the 
surface of the finger. 

In all inflammations of the pharynx, larynx, fauces, and mouth, solu- 
tions of silver nitrate are to be used in varying strength. Sometimes 
after slight exposure to cold or dampness the posterior wall of the 
pharynx suddenly becomes sore and raw, feeling as if the mucous mem- 
brane had been scarified. A solution of nitrate of silver will relieve 
this, and if it is employed in the strength of 60 grains to the ounce of 
water the application will be more efficacious and less painful than if 
weaker solutions are employed. 

In laryngeal phthisis a spray used from an atomizer in the strength 
of J to 2 grains to the ounce of water may do good service. 

In whooping-cough Ringer recommends the use of a spray in the 
strength given above for the purpose of relieving the cough in its vio- 
lence and frequency and of obtaining a good night's rest. The appli- 
cations should be made when the stomach is empty, as they are apt to 
bring on retching. The end of the atomizer must be within the mouth 
or the skin of the face will be stained. 

In the later subacute stages of gonorrhoea an injection of nitrate of 
silver of the strength of 2 to 4 grains to the ounce is very useful. 

In uterine ulceration and in leucorrhoza, when the cervix is boggy 
and tender, the application of the solid nitrate of silver stick is of ser- 
vice. Its use is often followed by headache about the vertex, and this 
in turn is to be relieved by 10-grain doses of the bromides. 

In pruritus pudendi, ani, and vulvce a solution of 4 to 6 grains to the 
ounce should be painted with a camel's- hair brush over the parts to 
relieve the itching. The application is to be made from two to four 
times a day. 

Bed-sores may be aborted if, as soon as the skin reddens, a solution 



248 DRUGS. 

of nitrate of silver of the strength of 20 grains to the ounce is applied 
with a brush to the part. This measure fails in paralytics. 

Boils which begin in a small limited papule with a surrounding 
area of inflammation may be aborted by the use of a strong solution 
of this salt. 

In granular lids, conjunctivitis, and similar affections about the eye 
the use of the nitrate of silver in stick form or in solution is largely 
and successfully employed. (See Conjunctivitis.) 

When it is desired to remove nitrate of silver stains they should be 
washed with a solution made of cyanide of potassium 2 J drachms, 
iodine 15 grains, and water 3 ounces. 

Administration. — The dose of nitrate of silver is J- to \ of a grain 
in pill form. Mitigated caustic, or diluted nitrate of silver (Argenti 
Nitras Dilutus, U. S., Argenti et Potassii Nitras, B. P.), is composed of 
equal parts of nitrate of silver and potassium nitrate, and is used as a 
mild caustic. 

The drug when given continuously for a long time should be dis- 
continued for four or five days at the end of the second week, as it is 
so slowly eliminated as to accumulate in the body and cause argyria. 



NITRIC AOID. 

Nitric acid (Acidum Nitricum, U. 8. and B. P.), the strongest and 
most corrosive of the mineral acids, is a clear liquid, becoming slightly 
yellow with age, which acts, when in pure form, upon the tissues of 
the body as a powerful caustic. Applied to the mucous membranes, 
well diluted, it acts as an irritant or astringent, and when taken inter- 
nally exerts a stimulating influence over the secretory glands of the 
stomach and small intestines. 

It does not tend to relax the bowels as does nitro-hydrochloric acid. 

Poisoning. — When nitric acid is taken in concentrated form it pro- 
duces a widespread gastro-enteritis, great pain in the mouth, oesophagus 
and abdomen, and finally death, from the inflammation induced, or 
from collapse. If the patient survives the acute stages he may die 
from secondary changes in the stomach and bowels, such as stricture 
or destruction of the peptic tubules. The stain made by the acid about 
the mouth and clothes is deep lemon yellow. Renal irritation is often 
a severe symptom, and the passages from the bowels and the urine 
may be bloody. 

The antidotes are any alkali of a mild type, as magnesium, chalk, 
or whitewash from the walls of the room ; the use of oils and opium 
to relieve irritation, and the proper maintenance of bodily heat. 

Therapeutics. — Nitric acid is used externally in medicine as a caustic 
for chancres and chancroids, the surrounding tissues being protected by 
oils or ointments. 

It may also be used on warts, in cases of gangrene to destroy the tis- 
sues, and on phagedenic ulcers. Whenever the acid is to be applied for 
such purposes a solution of soap and water should be at hand to neu- 



NITRITE OF POTASSIUM. 249 

tralize its effects as soon as it has acted deeply enough. Nitric acid is 
also used externally in a dilute form, 5 to 30 drops to the ounce, as a 
stimulant and astringent to indolent ulcers. Internally, nitric acid is 
used as a tonic and astringent In the oxalic acid diathesis when 
oxaluria is present, nitric acid will give relief when nitro-muriatic acid 
cannot be obtained, although the latter is far preferable. When small 
ulcers exist in the mouth, or stomatitis is present, 3 drops of nitric acid 
at a dose, in water, will often be of service, but it should be taken 
through a tube to protect the teeth. In gastric indigestion, in which, 
soon after a meal, sour food regurgitates into the mouth, a few drops 
of nitric acid will often give relief. In intestinal dyspepsia coming on 
some hours after meals, and in which not only discomfort but pain 
may be felt in the hypochondrium, nitric acid with some simple bitter 
tonic is most efficient, and it will often cure the green diarrhoea of 
children, particularly in the summer, bringing about these changes 
not only by its astringent power, but also by its stimulating effect on 
the intestinal glands. Combined with some good pepsin it will give 
relief in the chronic diarrhoea of children associated with lientery, and 
in which the stools may be pasty or watery and at the same time 
ill-smelling. 

Ringer recommends the employment of nitric acid in the treatment 
of piles. The strong acid should be used and simply touched to one or 
two points, not swept over the whole surface. The pain is very slight, 
or none at all may be felt. A slough results, and finally comes away 
leaving a cicatrix which as it contracts diminishes the size of the pile. 

The same author also states that a lotion of dilute nitric acid in the 
proportion of J to 1 drachm to a pint of water is of service in 
bleeding haemorrhoids, arresting the bleeding, constringing the parts, 
and relieving the sensation of weight and fulness so often a pressing 
symptom. 

The dose of dilute nitric acid (Acidum Nitricum Dilutum, IT. S. 
and B. P.) is 3 to 15 drops well diluted and taken through a tube, 
to protect the teeth. 

NITRITE OP POTASSIUM. 

Nitrite of Potassium is a salt used largely in modern medicine to 
take the place of nitrite of amyl, but it possesses greater stability, and 
is, therefore, more permanent in its effects. It is used for the relief of 
angina pectoris or heart-pang, in the treatment of gastralgia aucl even 
in epilepsy. The dose is from 3 to 5 grains, although much larger 
doses have been employed. These larger doses are, however, not 
devoid of danger. Nitrite of potassium is eliminated by the lungs 
and by the kidneys as a nitrate. 

Oobalto-nitrite of Potassium. 

This preparation has been suggested and tried successfully as a sub- 
stitute for the nitrite of potassium. As it is a more stable compound 



250 DRUGS. 

it is less rapidly broken up in the system, and so exercises a more pro- 
longed influence. For this reason it does not act so vigorously or 
suddenly, which is a great advantage in some cases. Its use is identical 
with that of the rest of the nitrite group. The dose of cobalto-nitrite 
of potassium is J grain every three hours. 



NITRO-GLYOERIN. 

Nitroglycerin is a compound which, in its pure state, is used largely 
as an explosive, but it is employed in medicine in a dilute form, as a 
useful drug in those instances where a somewhat rapid and powerful 
effect is to be exercised over the vascular system. Its physiological 
action is identical with that of the other nitrites, such as the amyl 
nitrite, except that it is not so fugacious as the latter, nor so persistent 
in its effects as the nitrites of sodium and potassium. The dose is 1 to 
2 drops of a 1 per cent, solution in a little water or in a pill, and no 
more than this may be employed at one dose unless the patient takes 
the remedy for a considerable period of time, when as much as 10 
drops may be administered. The drug is largely employed in angina 
pectoris, and sometimes in epilepsy and chorea and in gastralgia. 
Da Costa and others have highly recommended this drug in the treat- 
ment of chronic parenchymatous nephritis, as it very distinctly de- 
creases the eseape of albumin from the kidneys. In interstitial 
nephritis, with cardiac disturbance resulting from the renal changes, in 
which there is a marked increase in arterial pressure, so that ausculta- 



tion reveals at the second right costal cartilage an accentuated second 
sound due to the forcible closure of the aortic leaflets, nitro-glycerin 
often produces a good effect by reducing the pressure and relieving the 
heart of strain. When attacks of angina pectoris seem to be accom- 
panied or preceded by marked vascular spasm nitro-glycerin is also 
indicated. In cases of asthm,a dependent upon engorgement of the 
mucous membranes of the bronchial tubes it is very serviceable. The 
solution used in medicine is too weak to be explosive. Tablets of 
nitro-glycerin (Tabellce Nitro-glycerini, B. P.) each contain T ^-g- of a 
grain. Mtro-glycerin is sometimes called trinitriue or glonoin. 



NITRO-HYDROOHLORIO ACID. 

Nitro-hydrochloric Acid (Acidum Nitro-hydrochloricwn, U. S.) is a 
liquid giving off a distinct odor, and possessed of a very caustic power, 
staining the tissues of the body a light yellow. It is official in the 
form of the dilute acid (Acidum Nitro-hydrochloricum Dilutum, U. S. 
and B. P.) which is often lemon-yellow, in which case it is useless ex- 
cept as an ordinary acid. According to the U. 8. P. it must be orange- 
yellow. When we wish to use the acid for its own peculiar effects, the 
official dilute acid ought always to be supplanted by the freshly mixed 
strong acid and be of an orange color. If this cannot be obtained the 



NITRO-HYDROCHLORIC ACID. 251 

physician should prepare the compound for himself by adding 4 parts 
of medicinally pure nitric acid to 16 parts of hydrochloric acid, and 
allowing the mixture to stand in an open bottle until the fumes are 
no longer given off in excess, when it must be tightly corked and 
kept in a dark place. This acid ought to be freshly prepared every 
few days. 

Poisoning. — The symptoms caused by poisonous doses are those of 
violent gastro-enteritis with vomiting and purging of bloody matters. 
Death may occur from perforation of the alimentary canal, from in- 
flammation of the abdominal viscera, and from destruction of the 
peptic tubules or constrictions of the oesophagus or bowel. The 
treatment consists in the use of alkalies such as magnesium, lime, 
whitewash, soap, and oils, with opium to allay irritation. The use of 
external heat to prevent collapse is also to be resorted to. 

Therapeutics. — Nitro-hydrochloric acid is an invaluable remedy in 
many cases of indigestion arising either in the stomach or bowels, as 
it acts as a tonic and stimulant to secretion Upon the biliary flow 
its action is quite marked, and it may even cause bilious purging if 
pushed to any extent. It is therefore largely used in hepatic torpor, 
either acute or chronic, and in the early stages of hepatic cirrhosis 
should always be resorted to. In the chronic hepatitis of hot climates 
it is exceedingly useful, but it is not to be employed in acute sthenic 
hepatitis, as it is a stimulant to the liver, which, under these conditions, 
needs quieting. When used in chronic hepatitis, it should be given in 
full dose and pushed to its physiological limit, as evidenced by the 
bilious purging produced, or by signs of gastro-intestinal irritation. 

A useful additional means for obtaining the beneficial effects of this 
acid is to use it by means of the foot-bath or general bath. As used 
by Johnson in India, the acid lor this bath is prepared by slowly and 
carefully adding together 2 parts of nitric acid, 3 parts of hydrochloric 
acid, and after twenty minutes mix carefully with these distilled water 
5 parts. For the general bath (in a wooden tub) take 5 pailfuls of 
water, 64 fluidounces of the acid mixture, and enough boiling water to 
raise the temperature to 98°. Keep the patient in the bath twenty 
minutes. Then rub him thoroughly with warm towels and place him 
in a dry, warm bed. For the foot-bath add 6 ounces of the acid to 2 
gallons of water at 98° and bathe the thighs and calves of the legs for 
twenty minutes with a sponge wet with the mixture. This is a very 
useful treatment according to Stille" for cases of alcoholic hepatic torpor. 
If in either case the skin becomes irritated less acid is to be used. 

In ordinary so-called biliousness, which is not biliousness, but in- 
testinal indigestion, this acid is often of great service. (See Indiges- 
tion and Biliousness.) It is also of value in dysenteric diarrhoea 
where the dysentery rests upon defective secretory action on the part 
of the glands which pour out the proper fluids for digestion. In 
chronic diarrhoea its persistent use for a week or two should be tried. '• 

Administration. — The strong freshly mixed acid should be given to 
the adult in the dose of 1 to 3 drops three times a day, well diluted, 
and taken through a tube after meals. If the patient is intelligent he 



252 DRUGS. 

should be ordered J ounce of the pure acid and told how to drop it. 
If he is not, the physician roust order it partly or entirely diluted in 
the prescription, and in so small an amount that it may be renewed 
before it loses any of its power. Warning should be given of its 
effects on any clothes with which it may come in contact, aud care 
should be taken that the bottle is held some distance away from the 
face when the cork is withdrawn, as the acid, if it is fresh, may fly 
out and burn the eyes and face. 



NITROUS OXIDE. 

This gas is obtained by a complicated process which requires the 
use of such cumbersome apparatus that its manufacture is out of the 
question for the ordinary practitioner of medicine, and the fact that 
several large firms prepare the gas and sell it in cylinders ready for 
use renders its preparation on a small scale unnecessary. The gas is 
devoid of odor but possesses a slightly sweet taste. 

Physiological Action. — Owing to the symptoms sometimes produced 
in patients inhaling this gas, it has received the popular name of 
" laughing gas," but a condition of hilarity is rarely seen when the 
inhalations are full and deep, and only comes on in the majority of 
cases where the gas is taken in small amounts or very slowly. When 
used properly, the patient is directed to take long deep inspirations 
from the tube placed in the mouth, the nose being held so that the 
nostrils are closed. Under these circumstances the face becomes for a 
moment flushed, then of a deadly pallor, and finally the jaw drops if 
the effect is very great. At this time anaesthesia is complete and the 
operation is to be rapidly performed. 

According to the most recent studies upon this gas (Wood and 
Cerna) it causes at first a rise of arterial pressure, followed by a fall 
if the asphyxia caused by its inhalation is very severe. The 
anaesthesia is probably chiefly due to the non-oxygen ation of the 
blood during the time the gas is in this fluid, or, in other words, it is 
largely due to asphyxiation. It has been thought that the use of 
this drug produced temporary glycosuria, but recent studies render 
this doubtful, to say the least. Where permanent glycosuria has been 
produced, some injury to the vascular system in the region of the 
diabetic centre in the floor of the fourth ventricle has in all proba- 
bility occurred. The gas ought not to be given to those who are 
advanced in years or have atheromatous bloodvessels, since the rise of 
arterial pressure consequent upon the asphyxia may rupture a cerebral 
bloodvessel and thereby cause an apoplexy. Nitrous oxide gas when 
inhaled very rarely produces any disagreeable after-effects, save a little 
light-headed sensation or dizziness for a few hours. 

Therapeutics. — Nitrous oxide is a useful . anaesthetic in all minor 
operations, such as opening an abscess, boil or felon, or even ampu- 
tating a thumb. It possesses two disadvantages, the first of which is 
its brevity of action, since its continued administration is dangerous ; 



xui vomica. 253 

the other, the difficulty in carrying it about from place to place. It 
possesses a great advantage in almost absolute safety, very few deaths 
having been caused by it directly. It is the safest of all anaes- 
thetics, not even excepting cocaine, which latter drug has largely 
supplanted the gas for many minor surgical operations. When teeth 
are to be extracted a plug or cork is placed between the jaws before 
the gas is given, to keep them apart. Under these circumstances the 
cork should always be attached to a string, so that if it slips into the 
back part of the mouth it may be withdrawn before it chokes the 
patient to death. 

NUTMEG. 

Myristica, U. S. and B. P., or Nutmeg, is the kernel of the seed of 
Myristiea Fragrans, an East and West Indian Plant, Mace being the 
outside covering of the same. Nutmeg is a soporific and nervous seda- 
tive exercising a peculiar influence over the cerebrum. It is also used 
as a flavoring substance in somnifacient mixtures, and is of value in 
prescriptions for serous diarrhoea. The oil (Oleum Myristicce, U. S. 
and B. P.) is given in the dose of 1 to 3 drops. The spirit or essence 
(Spiritus Myristicce, U. S. and B. P.) is used in the dose of 1 to 2 
fluidrachms. 

Several cases of poisoning by nutmeg are reported — the most recent 
by Dr. Reading, of Woodbury, N. J. The symptoms closely resemble 
those produced by excessive doses of cannabis indica. 



NUX VOMICA. 

Nux Vomica (U. S. and B. P.) is the seeds or beans of the 
Strychnos Nux Vomica, an East Indian tree. It contains two alka- 
loids, strychnine and brucine, and depends largely for its medicinal 
power on the former. For this reason the statements made in regard 
to the physiological action of strychnine may practically be considered 
as applicable to the entire drug. 

Physiological Action.- — When strychnine is given to man or the 
lower animals in full medicinal dose it increases reflex activity, respi- 
ratory rate, pulse- force, arterial pressure, acuity of vision and hearing, 
and causes general systemic irritation or excitement. 

Xeevous System. — On the nervous system strychnine exerts its 
chief influence. It excites the spinal cord in its motor tracts and 
probably increases the receptive activity of the sensory centres. It 
also has some slight influence in increasing the conductive power of 
the motor and sensory nerves. 

In overdose strychnine produces spinal or tetanic convulsions by an 
action exerted on the spinal cord. When enormous- doses are given 
intravenously total paralysis, resembling that caused by curare, pre- 
cedes the convulsions, and if artificial respiration is not used the 
animal dies from failure of respiration. If death takes place from 



254 DRUGS. 

the effects of the drug the motor nerves are found to be depressed, 
partly as the result of the poisonous action of the strychnine and 
partly as the result of the exhaustion of the nerve-trunks by the 
convulsing impulses which they have carried. 

Circulation. — Nux vomica increases the force of the pulse-beat 
and the pulse-rate by a stimulation of the heart muscle and its ganglia, 
while the rise of arterial pressure which it causes is clue to stimulation 
of the vasomotor centre. If very poisonous doses are injected intra- 
venously a fall of arterial pressure occurs instead of a rise, which is 
due to vasomotor depression and paralysis. 

Respiration. — Strychnine is one of the most constant and pow- 
erful stimulants to the respiratory centre that we have, and it not 
only increases the rate but the respiratory capacity. 

Temperature. — Ordinary doses have no effect upon temperature, 
but poisonous doses may raise it by reason of the convulsions. 

Elimination. — Strychnine is eliminated from the body by the 
kidneys as strychnine and strychnic acid. Most of it is oxidized and 
destroyed by the liver. 

Poisoning. — When a poisonous dose of strychnine is taken it acts 
either suddenly or gradually. If suddenly, the man or animal may 
be, without any premonition, thrown several feet, and become rigid, 
by contraction of his muscles. 

If the onset is gradual, some stiffness at the back of the neck and 
uneasy startings may precede the general nerve-storm. The con- 
vulsions are tetanic, or in other words tonic, and the body is thrown 
into opisthotonos, that is, resting on the head and heels at each con- 
vulsion. 

Sometimes the trunk is twisted sideways, or with the back in the 
air. (Emprosthotonos.) The eyes are open and fixed, the corners of 
the mouth drawn back into risus sardonicus, and respiration, during a 
severe convulsion, is impossible owing to the respiratory muscles being 
in a state of tetanic rigidity. 

The slightest noise, draught of air, or touch, may cause a convulsion, 
or convulsion after convulsion, because the sensory impulse, reaching 
the spinal cord, causes a spasmodic motor impulse to be sent out to 
the muscles. 

The convulsions are not absolutely continuous, but periods of utter 
or partial relaxation occur, during which the patient breathes easily. 
The cramp-like contractions of the muscles are exceedingly painful, 
and the patient either dies of cramp asphyxia — that is, through failure 
of respiration, because his chest muscles are locked in spasm, or much 
more rarely, from exhaustion. Reichert has shown that it requires 
five hundred times the fatal dose of strychnine to cause death if 
artificial respiration is properly maintained. 

Treatment of Poisoning. — The attendant should give at once, if 
no symptoms have yet appeared, inhalations of nitrite of amyl, and 
meanwhile employ the stomach-pump, using the nitrite to prevent 
any convulsive tendencies during the operation. Draughts of water 
containing tannic acid, as the chemical antidote, are to be adminis- 



NUX VOMICA. 255 

tered, and after the stomach is washed out 60 grains of bromide of 
potassium and 20 grains of chloral in solution are to be given. 
These are the physiological antidotes, for the bromide of potassium 
depresses the sensory side of the spinal cord, and the chloral depresses 
the motor tracts. If the convulsions prevent swallowing, the patient 
.must be chloroformed with care, and the physiological antidotes given 
in starch-water by the rectum, muscular relaxation being maintained 
by the anaesthetic until the drugs are absorbed. Ether cannot be used 
as a relaxant, as it is too irritant and too slow. Nitrite of amyl is also 
a physiological antidote, but it is useless if a complete convulsive attack 
is present, as it cannot be inhaled if the chest is immovable. Neither 
can any other relaxant, such as chloroform, be used under those circum- 
stances. These drugs should be gently given between the paroxysms. 
If relaxation does not occur, the nitrite of amyl should be injected 
hypodermically. 

AYhile a light touch may produce a spasm, a firm, hard grasp of 
the limb often relieves the pain of the cramp. Sensation and con- 
sciousness is preserved in strychnine-poisoning unless the asphyxia 
destroys it. 

Differential Diagnosis. — The convulsions of strychnine-poisoning 
do not resemble epilepsy, because they are so distinctly tonic, and 
never clonic. From tetanus strychnine-poisoning is to be separated 
by the fact that in tetanus the locking of the jaws comes first, while 
in strychnine-poisoning it comes last. The convulsions of tetanus 
rarely, if ever, completely relax, while those of strychnine do have 
periods of relaxation. There is a different history in each case. In 
one, perhaps, of an injury, as of a nail run into the foot; in the other, 
of a dose of poison having been swallowed. 

The differential diagnosis of strychnine-poisoning from hysterical 
convulsions is more difficult. The convulsions are rarely so persist- 
ently tonic in hysteria, and the peculiar expression of the hysterical 
face is often seen in such cases. The history of the patient, if obtain- 
able, will throw much light on the case, and aid very materially in the 
separation of the two conditions. 

As the treatment of all these states is virtually identical, the em- 
ployment of the measures just suggested may be resorted to in each 
instance, and the diagnosis made afterward. 

Therapeutics. — Nux vomica, or its chief alkaloid, strychnine, is 
used for several purposes in medicine. Owing to its bitter character- 
istics it may be employed as a simple bitter tonic or as one especially 
influencing the nervous system. It may also be used as a respiratory, 
cardiac, and ocular stimulant. 

In cases of functional nervous atony, or depression, strychnine does 
good, but in organic disease, if used during the period of acute in- 
flammation, as after an apoplexy or in acute infantile palsy, it is dis- 
tinctly harmful. Some cases of apoplexy can never take the drug 
without a spasm coming on in the paralyzed part or parts. In acute 
or subacute neuritis strychnine ought never to be used in any way 
whatever, as the nerves are already inflamed, and are not to be still 



256 DRUGS. 

further irritated by the employment of nervous excitants. In pro- 
gressive lead palsy large closes of strychnine should be constantly used 
to stop the progress of the disease, iodide of potassium also being 
employed to cause the elimination of the lead. 

In amaurosis dependent upon the excessive use of tobacco or alcohol 
strychnine is almost a specific, and in eye-strain resulting from in- 
sufficiency of the ocular muscles it does great good, curing the insuf- 
ficiency and improving the general condition of the muscles. Accord- 
ing to De Schweinitz, the patient should use ascending doses of the 
tincture of nux vomica, beginning with 3 drops three times a day, 
and increase the amount 2 drops a day until distinct physiological 
effects are produced. Sometimes 60 drops may be used in twenty- 
four hours after tolerance is reached. 

There is no drug known which is so antidotal to the effects of over- 
doses of chloroform as is strychnine. In cases of sudden accident 
during the use of this anaesthetic, the physician should give hypodermic 
or even intravenous injections of -^V grain of strychnine as a power- 
ful, rapidly acting cardiac and respiratory stimulant. 

In dyspnoea, from any cause, such as that of old persons with 
winter cough or bronchorrhoea, in emphysema, phthisis, and in idio- 
pathic shortness of breath, strychnine is of service, and it is a valuable 
drug for the treatment of opium-poisoning, preserving the reflexes and 
stimulating the respiratory centre. 

Strychnine is a very valuable remedy in surgical shock, and is a 
better antidote to opium than is belladonna. 

In atony of the bowels strychnine is of service, and it is to be added 
to purgative pills to avoid their depressing after-effect on the intes- 
tines. Where a lesion exists in the brain, strychnine may be used to 
keep up the nutrition of a limb which is paralyzed, but if the palsy 
be due to disease of the trophic cells in the spinal cord, it does little 
good except to stimulate the remaining cells to greater effort. 

The following prescription is a useful one in gastric and intestinal 
atony and in chronic bronchitis : 

Be. — Tr. nucis vomicae f^j. 

Liq. potassii arsenitis f^ss. 

Aquae q. s. ad f^iij. M. 

S. — Teaspoonful t. d. after meals. 

According to Ringer, sick headaches, due to errors «in diet and with- 
out much nausea, can be put aside for the day by the use of a drop of 
the tincture of nux vomica in a teaspoonful of water every five or ten 
minutes until 10 drops are taken. 

Administration. — Abstract of nux vomica (Abstractum Nucis 
Vomicae, U. 8.) is given in the dose of J to 1 grain ; the extract 
(JExtractum Nucis Vomica?, U. 8. and B. P.), in the dose of ^ to J of 
a grain ; the fluid extract (JExtractum Nucis Vomicae Fluidum, TJ. 8.), 
in the dose of 1 to 5 drops; the tincture (Tinctura Nucis Vomicae, 
U. 8. and B. P.), in the dose of 5 to 30 drops. 8trychnino3 Sulphas, 



opium. 257 

U. S. and B. P., is given hypodermically in the dose of -^ to -^V °f 
a grain, and by the mouth in the same amounts. 



OPIUM. 

Opium (TJ. S. and B. P.) is the juice or milky exudation appearing 
on the surface of the unripe capsules of White Poppy or Papaver 
Somniferum, a native plant of Asia, now grown in many other parts 
of the world. 

Good opium, accordiug to the U. S. P., should contain at least 9 per 
cent, of morphine. 

The chemical composition of this drug is very complex, no less than 
seventeen alkaloids having been obtained from it, the most important 
of which are Morphine, Codeine, Narcotiue, Thebaine, Narceine, 
Papaverine, Pseudomorphine, and Laudanine. It also contains 
Meconic Acid and Meconine. 

Physiological Action. — Opium, when given in full dose, produces 
in the lower animals, such as the frog, violent spinal convulsions ; in 
the dog, great increase in reflex activity, and in man deep sleep, the 
spinal symptoms being in abeyance. 

Nervous System. — Opium has a double action on the nervous 
system. It quiets the brain but excites the spinal cord if given in 
very large doses. In the frog, which has no brain of any size, the spinal 
action predominates ; in man, whose brain is proportionately larger 
than his spinal cord, the cerebral effect is the dominant influence. In 
the animals between the frog and man opium either produces convul- 
sions and sleep, or sleep alone. If the dose is large, the spinal cord 
becomes depressed in all animals and the reflexes fail. The motor 
nerve-endings are also somewhat depressed under these circumstances, 
but the sensory nerves generally escape. 

Circulation. — Small therapeutic doses of opium have no effect 
upon the circulation, but large ones slow the pulse, increase its force, 
raise arterial pressure and cause the respirations to become deepened 
and more full and at the same time a little slower. 

The slowing of the pulse depends upon stimulation of the pneumo- 
gastric nerves peripherally and centrically ; the increase in pulse-force 
rests upon the stimulation of the heart muscle and its ganglia ; the rise 
of pressure is due to the increased heart action and vasomotor stimu- 
lation. 

After poisonous doses all these changes become more marked, and 
finally go on into a rapid running pulse and great depression, due to a 
reversal of all the influences named ; the vasomotor centre is depressed, 
as are also the pneumogastric nerves. 

Respiration. — In very minute doses opium is a feeble stimulant, 
or at least not a depressant, to the function of respiration. In overdose 
it is one of the most powerful paralyzants of the respiratory centres 
in the medulla oblongata, causing death in this way. 

17 



258 DRUGS. 

Temperature. — The bodily temperature is raised slightly by full 
doses and lowered by poisonous amounts of opium. 

Tissue- waste. > — Opium acts as a preventive to tissue-waste, 
decreasing the elimination of urea and other results of nitrogenous 
breakdown. 

Elimination. — The drug escapes, if given in excess as morphine, 
chiefly by way of the intestines and kidneys, but most of it is destroyed 
in the body. Experiments made by Alt and Tauber show that 
morphine is chiefly eliminated by the stomach, and that if this viscus 
is frequently washed out during a case of poisoning, recovery is much 
aided, as by this means reabsorption is prevented. 

Pupil. — Opium contracts the pupils by a centric stimulation of the 
oculo-motor nerves, and perhaps by depression of the sympathetic 
fibres. 

Stomach, Intestines, and Secretion. — Opium depresses the 
motor activity of the stomach and intestines and produces constipa- 
tion. 

It does this by stimulating the splanchnic inhibitory fibres of the 
intestine and thereby preventing peristalsis. In very large doses it 
increases peristalsis by paralyzing these fibres. 

Opium checks every secretion in the body except that of the skin. 

Acute Poisoning. — When opium is taken by man in overdose it 
causes drowsiness, deep sleep, full breathing, a slow, full pulse, a warm, 
dry skin, contracted pupils, and pleasant, or, more commonly, in the 
Anglo-Saxon race, disagreeable dreams or no dreams at all. 

Preceding this period there may be a brief one during which the 
person feels self- satisfied and coutented. The duration of this agreeable 
sensation only lasts a short time, and if the dose is large does not occur 
or at once passes off. It has been called the first stage, while the 
more marked symptoms just described have been grouped into a so- 
called second stage. 

During the sleep of the second stage the patient can be roused by 
shouting in his ear or by violent shaking, but sinks back into slumber 
at once on being left alone. 

The face is suffused and reddened, and may be finally distinctly 
cyanotic. Many of the symptoms resemble those of congestion of the 
brain. The breathing may be puffing and stertorous. When the 
patient is awakened he breathes more rapidly, and for this reason the 
duskiness of the face disappears and the normal hue returns. Death 
never occurs in the second stage of opium poisoning from the poison 
alone, but if a complicating disease is present death may take place at 
this time. 

The third or fatal stage emerges from the second by a process so 
gradual that no abrupt line of separation can be noted. The face be- 
comes at first more cyanotic, then pale and livid, the respirations, which 
have been 8 to 10 to the minute, are now only 4 or 5, and finally, such 
prolonged pauses occur that all hope of another respiration is lost by 
the attendant. While the slow breathing is at first deep it now rapidly 
becomes shallow, and muscular relaxation is present to the greates 



opictm. 259 

degree. The skin, previously dry, is wet with the sweat of death, and 
the patient is so deeply narcotized that nothing can arouse him and he 
dies from respiratory failure, although the heart .ceases almost simul- 
taneously from the asphyxia. The pupils do not dilate in the third 
stage, except in the relaxation of death. 

Treatment of Acute Poisoning. — After employing the usual 
methods resorted to for the purpose of unloading the stomach, and 
after giving tannic acid as the chemical antidote, the patient should 
receive one or two cups of strong black coffee, hot and concentrated. 
The heat in the liquid is useful in maintaining bodily temperature 
and the caffeine stimulates the respiratory centre and keeps the man 
awake. Coffee should be used even before any symptoms come on in 
order to put them off if possible. If atropine be at hand and the 
respirations are becoming very slow, y^ to -g 1 ^ of a grain should be 
given hypodermically, but this dose should not be repeated after the 
respirations increase to 10 or 12. Strychnine is, however, much 
better than atropine as an antidote to opium, and should be given 
hypodermically in full dose, repeated frequently enough to keep the 
nervous system of the patient active and respiration intact. The 
pupil is no guide as to the action of atropine, as the action of these 
two drugs on the eye is not antagonistic. 

Alcoholic stimulants may be called for, and ammonia as a cardiac 
and respiratory stimulant may be resorted to. 

In the third stage heat should be applied to the trunk and ex- 
tremities. 

Much emphasis has been placed on keeping the patient awake, and 
it has been thought that the cause of death was the deep sleep. This 
is not so. The man must be kept awake in order that he will supple- 
ment the efforts of his depressed respiratory centres by voluntary 
breathing. If he sleeps he forgets to breathe, and sleep means death 
for this reason, and not because sleep in itself produces death. 

Besides the use of the hot strong coffee, the patient may be kept 
awake by lashing him with switches or by keeping him walking up 
and down between two attendants. Both of these measures are repre- 
hensible if anything better can be done, the first method because it 
covers the patient with cuts and bruises, the second because it may 
aid in the production of death by exhaustion. If an ordinary medical 
electric battery is at hand the full force of the current may be allowed 
to come in contact with the skin from two small poles wet with salt 
water, or better still, the dry or wire electric brush should be swept 
over the body while the negative pole is held in the hand of the 
patient or pressed against his skin. This causes the most exquisite 
pain in the normal individual, but if the brush is kept moving will 
not cause any bruises or discoloration. (See Asphyxia.) Artificial 
respiration may be resorted to. 

Chronic Poisoning. — Morphine or opium when taken constantly 
generates a habit. The person, or morphine-habitue" as he is some- 
times called, depends for a comfortable existence on the drug, and day 
by day increases his dose until the most extraordinary amounts are 



260 DRUGS. 

taken by the stomach, or by means of the hypodermic needle. If 
the drug is withheld a train of symptoms typifying depression or 
exhaustion ensues. The pulse is scarcely to be felt, horrible mental 
depression and melancholia come on, the miserable man or woman 
wrings his or her hands, and begs, screams, howls, or yells for mor- 
phine, only to break down and cry at its withdrawal. Diarrhoea, of 
a serous type and most violent in character, with cramps in the mus- 
cles, may assert itself, and must be controlled by astringents and an 
active line of treatment, as far as possible free from opium. 

A characteristic symptom of chronic opium-eating is the develop- 
ment of the most remarkable and clever lying, in previously truthful 
persons. In the breath that the patient begs the physician to cure 
him and not give him another dose of morphine, he will lie to obtain 
the drug in a surreptitious manner and may even have the drug in 
his mouth at the moment he speaks. It will often be found hidden 
in the seams of the clothing in small packages, and the nurse should 
be absolutely reliable and forever on the watch lest the drug be 
obtained by smuggling. Any sudden improvement on the part of 
the patient should be placed to the credit of more morphine, not to 
professional skill. 

Treatment. — The best way to treat such cases is to " taper off " the 
daily dose, and to decrease a sixth or fourth of the total customary 
amount in each twenty-four hours. The complete withdrawal of the 
drug is an unnecessarily severe measure, and its withdrawal in a slower 
manner than that named is simply prolonging the treatment beyond 
reasonable limits. Cocaine has been used to tide over the crisis after 
the withdrawal of morphine, but too frequently the patient passes 
from opium to the cocaine and finally to the alcohol habit, all of which 
are equally bad. If the circulation flags, digitalis and strychniue may 
be given and the remaining symptoms treated as common sense in- 
dicates. 

Sometimes paregoric is taken in excess, aud the writer has seen and 
treated a case under the care of Dr. H. C. Wood which took over a 
pint of paregoric every day. 

When a mother is an opium-eater the newborn child often suffers 
from collapse on the second or third day after its birth, owing to the 
lack of its customary dose of opium. 

Therapeutics. — Opium is used for relief of five great conditions 
which will be spoken of seriatim, the minor uses of the drug being 
considered afterward. 

Pain. — Opium, as is known to every one, is the best remedy that 
we possess for the relief of all forms of pain, except in those instances 
where neuralgia exists, when antipyrine and its fellow-compounds 
exceed it in medicinal value. In one form of pain the drug is not to 
be employed, namely, that arising from cerebral congestion or cerebritis, 
for it is distinctly contra-indicated in these affections, as it makes 
them worse. In acute or traumatic meningitis, however, opium is of 
great service, either alone or combined with mercury in sthenic cases. 
In the treatment of cases of renal and hepatic colic associated with 



opium. 261 

spasm, and in dysmenorrhea, belladonna and opinm given together 
will relieve the spasm and pain, and yet so counteract each other else- 
where in the body as to be devoid of effect upon other organs. Per- 
sons suffering from pain will always bear very much larger amounts 
of opium than painless individuals. 

Insomnia. — Opium, while capable of producing sleep in almost 
every case to which it is given, save in those persons who by reason of 
idiosyncrasy are made wakeful by it, is only to be used in those 
instances where the sleeplessness is due to pain. If constantly used 
in insomnia or in pain, the opium habit is rapidly contracted, and for 
this reason the use of the drug should be alternated with chloral, 
cannabis indica, and other soporific drugs. 

In some cases chloral and morphine when given in small doses in 
combination will so act upon the brain as to produce sleep. 

In the insomnia of typhoid fever, opium may be used, particularly 
during convalescence, but it must be employed most carefully. 

Inflammation and Irritation. — Opium seems to possess some 
influence over inflammation which we cannot explain, and both small 
and large doses are particularly valuable in inflammations of serous 
membranes, such as peritonitis, meningitis, and pericarditis. It allays 
the nervous excitement and anxiety following hcemoptysis, and the 
intense unrest caused by itching skin diseases, as, for example, the irri- 
tation of smallpox. Sometimes intense irritation or inflammation pro- 
duces so great an effect upon unstriped muscular fibres as to cause 
spasm or paralysis, as in retention of urine, cystitis, or the consti- 
pation following inflammation of the bowels from irritating foods ; 
under these circumstances the employment of opium is indicated, and 
is usually very successful. In irritative couglis morphine does good, 
given in syrup of wild-cherry bark, in the dose of -^ to y 1 ^ of a grain. 

In some cases of irritable cough due to tickling in the larynx, a 
drachm or two of paregoric added to hot water and the steam inhaled 
gives great relief. 

"Whenever the cough is in excess of the expectoration, that is, greater 
than is necessary to free the lung from mucus, morphine may be given 
in small doses. If the lungs contain more rales after than before its 
use it must be stopped, as the increase in the number of rales indi- 
cates an increase in the accumulation of mucus. 

In the treatment of strangury and rectal inflammation, provided 
they are not acute, after operation on the pelvic organs, and in cystitis, 
suppositories, in the strength of J or J of a grain of the watery extract 
of opium, are very useful. In excessive vomiting from any cause, ex- 
cept it be from a previous dose of opium, injections of laudanum and 
starch- water, with 20 grains of bromide of sodium, will be found of 
value. (See Vomiting.) 

For sprains and bruises lead-water and laudanum is one of the best 
applications. If the skin is broken laudanum may be used alone to 
relieve pain, and, by its alcohol, to act as an antiseptic. Opium is 
also a useful drug in the treatment of internal and external burns, to 
relieve the pain and irritation. 



262 DRUGS. 

Over-secretion. — In serous diarrhoea, diabetes insipidus and mel- 
Utus, and in the treatment of over-secretion on the part of all secreting 
surfaces except the skin, opium may be used. 

It is said to decrease the amount of urine before decreasing the 
amount of the sugar in diabetes. 

Opium should not be used in mucous diarrhoea until after the 
mucus already present is swept out of the intestinal canal by castor 
oil or magnesium sulphate. Minute doses of -^ to -^ of a grain of 
morphine will sometimes check summer diarrhoea in children at once 
when given hypodermically. 

Systemic Strain. — In prolonged strain upon the system, as in 
great physical effort, or more frequently in old age, to smooth out the 
cares of the remaining years of life, and decrease worry, opium is 
useful. In asthenic fevers it is thought to be supportive, but its use is 
apt to cause so many other conditions, such as constipation, anorexia, 
or mental depression, that alcohol is much better for this purpose. In 
very advanced phthisis it is often justifiable to give enough opium to 
keep the patient free from pain and discomfort for the remaining 
hours of his life, but care must be takeu that the dose does not inter- 
fere with his breathing, and so hasten death. 

In muscular rheumatism and similar states, where a u cold" has 
been taken, opium in the form of Dover's powder will often produce 
a cure, particularly if employed in combination with hot drinks and a 
hot foot-bath. 

In heart disease, particularly of the mitral valves, the patient cau 
often breathe easily only when awake, starting up when he falls asleep, 
and gasping for breath. It is stated by some writers that morphine 
will relieve this state and permit sleep, but that it will not be of ser- 
vice in aortic disease. While this may be partly true, the drug will 
often give great relief in all forms of cardiac dyspnoea, and ought 
always to be tried. Care should be taken that the first dose is small, 
as in some instances it increases the discomfort. The relief obtained 
is supposed to be due to cardiac stimulation by the drug, and while 
this is, no doubt, correct, other cardiac stimulants, such as digitalis, 
will fail when morphine succeeds. The presence of cyanosis and 
lividity is said to be no contra-indication to the hypodermic use of 
morphine under these circumstances, provided the dose is not unrea- 
sonably large. 

Administration. — Recent studies upon the action of opium and its 
alkaloids show that it acts in an inhibitory manner upon gastric diges- 
tion and absorption, decreasing the amount of hydrochloric acid in 
the gastric juice. Unless there is an excess of acid present it is always 
well not to give opium or morphine at meal times, but some hours 
after. 

Opium itself is used in the form of the powder (Pulvis Opii, U. S.) 
in the dose of from J to 1 grain. The solid preparations are the de- 
narcotized opium (Opium Benarcotisatum, U. #.), Avhich is deprived 
of its narcotine, dose J to 1 grain, the pills of opium {Pilulce Opii, 
U. S.), each containing 1 grain, and the watery extract (Extr actum 



opium. 263 

Opii, TJ. S. and B. P.), dose £ to J a grain. Of the liquid prepara- 
tions we have paregoric (Tinctura Opii Camphor ata, TJ. 8., Tinctura 
Camphor ce Composita, B. P.), dose 1 drachm to 2 tablespoonsfuls ; 
laudanum {Tinctura Opii, TJ. 8. and B. P.), dose 10 to 30 drops ; the 
deodorized tincture (Tinctura Opii Deodorata, TJ. 8.), dose 10 to 30 
drops ; the Vinum Opii, TJ. 8. and B. P., or, as it is sometimes 
called, Sydenham's Laudanum, dose 5 to 10 drops ; and Acetum Opii, 
TJ. 8., or Black Drop, dose 5 to 10 drops. 

Under the name of Dover's Powder (Pulvis Ipecacuanhce et Opii, 
TJ. S.), a powder containing one grain of powdered opium, one grain 
of powdered ipecac, and eight grains of sugar of milk, is largely 
used. This is more efficacious if separated into fifths, and taken in 
divided doses. The tincture of ipecac and opium {Tinctura Ipecacu- 
anhce et Opii, TJ. 8.) is given in the dose of 4 to 15 minims. 

All the liquid preparations of opium are 10 per cent, strong except 
paregoric, which is much weaker. 

The preparations of opium official in the B. P., other than those 
named, are : Confedio Opii, dose 5 to 20 grains ; Extractum Opii 
Liquidum, dose 4 to 20 minims ; Pulvis Opii Compositus, composed 
of opium, pepper, ginger, caraway fruit, aud tragacanth, close 2 to 5 
grains; Tinctura Opii Ammoniata, dose J to 1 drachm; and Trochisci 
Opii (^0 g raui °f opium in each), dose 1 to 4. 

Pilula Saponis Composita, B. P., is purely a preparation of opium. 
It is sometimes necessary to give this drug to patients without their 
knowledge, and it may be prescribed in this way, the patient not 
learning from the prescription the nature of the medicine. 

The B. P. also recognizes a liniment (Linimentum Opii), and a 
plaster (Emplastrum Opii), for local application, and an enema {Enema 
Opii), composed of \ a drachm of the tincture of opium and 2 ounces 
of starch mucilage. 

Ordinary opium is apt to produce nausea and depression, as already 
stated, while the denarcotized opium is deprived of its narcotine, this 
being one of the chief causes of these disagreeable symptoms. The 
deodorized laudanum is substituted for the ordinary laudanum for 
the same reasons. Morphine is used to relieve pain rather than opium, 
because it does not cause so much constipation, but opium is better to 
check diarrhoea. Paregoric is particularly useful in diarrhoea because 
it contains a volatile oil and camphor. 

Untoward Effects. — Opium in many persons produces after its 
primary influence great nausea, and sometimes vomiting. The men- 
tal depression may be simply overwhelming, and the very fact of 
having to drag out existence is a curse. These symptoms are said to 
be largely done away with by the use of 20 grains of bromide of 
potassium, which must be taken at the same time as the opiate, and 
by employing the preparations of opium largely devoid of narcotine, 
such as the deodorized tincture. Haig is responsible for the assertion 
that as opium frees the blood of uric acid by causing its retention in 
the tissues of the body, the pleasant effects are so produced, and that 
the retention being cumulative, no sooner does the effect of the opiate 



264 DRUGS. 

pass off thau the uric acid is set free in the blood, and as a result de- 
pression ensues. He states that if salicylates are given with the opium 
the retention does not occur, and the unpleasant sequela? are much 
modified or prevented. After the untoward symptoms come on, coffee 
and stimulants may be used. 

Children bear opium badly, and some children are very much more 
susceptible than others to its influence. 

One-eighth grain of morphine has caused death in an adult when 
given hypodermically. If the drug enters a vein the patient may give 
one gasp and fall back apparently dead. Sometimes the drug causes 
collapse, or in other cases an eruption over the body. 

Codeine. 
(See p. 151.) 

Morphine. 

Sulphate of Morphine {Morphince Sulphas, U. S. and B. P.) is given 
in the dose of J- to J grain, either by the mouth or hypodermically. 
Besides the sulphate of morphine we have the acetate {Morphince 
Acetas, U. S. and B. P.), and the muriate {Morphince Hydrochloras, 
U. S. and B. P.), both given in the dose of J to J grain. In the 
U. S. Pharmacopoeia of 1870 a solution, Liquor Morphince Sulphatis, 
was official, dose 1 to 2 drachms, but it is no longer official, and should 
not be called for. Magendie's solution is sixteen times as strong as 
this liquor (16 grains to the ounce) and is not official. The words 
a Liquor Morphiuse Sulphatis" will generally cause Magendie's solu- 
tion to be dispensed in New York State, and care should be taken that 
poisoning does not result. Pidvis Morphince Compositus, U. S., is 
given in the dose of 10 grains ; troches of morphine and ipecac ( Tro- 
chisci Morphince et Ipecacuanhas, U. S.) are given 1 or 2 at a time. 

The following additional preparations of morphine are official in 
the B. P. .* Liquor Morphince Hydrochloratis, dose 10 to 40 minims ; 
Tinctura Chloroformi et Morphince, dose 5 to 10 minims ; Suppositoria 
Morphince and Suppositoria Morphince cum Sapone, each suppository 
containing J grain of morphine; Irochisci Morphince and Trochisci 
Morphince et Jpecacuanhce, each lozenge containing -^ of a grain of 
morphine, dose 1 to 4. Liquor Morphince Acetatis is given in 20 to 
40-minim doses. Injectio Morphince Hypodermica, B. P., contains 1 
grain of the acetate of morphine in each 10 miuims of water. 

It is said by Alt that morphine when given hypodermically is elimi- 
nated by the stomach and so causes nausea, but if the stomach be well 
washed out this is avoided. 

Incompatibles. — Morphine is incompatible with tannic or gallic acid 
or astringent solutions containing them, with alkalies such as potas- 
sium, sodium, and ammonium, but with the chloride of ammonium it 
is not incompatible. With tincture of chloride of iron it forms a 
deep red color. (Meconic acid.) 



OXIDE OF ZINC. 265 



OX-GALL. 

Inspissated Ox-gall (Fel Bovis Inspissatum, U. S.) is, as its name 
implies, dried ox-bile. It is used in medicine for the purpose of re- 
lieving certain forms of indigestion which depend upon deficient se- 
cretion of bile or which occur in persons who digest fats with difficulty. 
In full doses it is apt to cause some looseness of the bowels and it may 
be given with this object. When it is used the fact should be remem- 
bered that bile prevents the gastric juice from acting upon proteid or 
albuminous substances, shrivelling them up, and in addition so altering 
the gastric liquids as to decrease their digestive power. We learn, 
therefore, that this drug must be administered some hours after meals, as 
a rule, or in other words when gastric digestion is ended and intestinal 
activity is beginning. The dose of inspissated ox-gall, which is dried 
by evaporation from 100 to 15 parts, is 5 to 15 grains. Purified ox- 
gall (Fel Bovis -Purijicatum, U. S., Fel Bovinum Purificatum, B. P.) 
is given in the same dose as the inspissated bile. It is made by 
evaporating 3 parts of pure ox-gall to 1 part, and then adding to this 
part an equal amount of alcohol, which constituents are mixed thor- 
oughly, and after standing twenty-four hours the clear liquid is 
decanted and the residue is evaporated to a consistency capable of 
forming a pill. 

OXIDE OP ZINO. 

Commercial Oxide of Zinc (Zinci Oxidum Venale) is not used in 
medicine, but in the purified form is largely employed in the shape of 
Zinci Oxidum, U. S. and B. P., which is insoluble in water. In the 
form of the oxide of zinc ointment ( Unguentum Zinci Oxidi, U. 8. and 
B. P.) this drug affords one of the most generally used applications in 
the treatment of skin diseases, burns, and sores. 

In all states where the surface of the skin is dry it is contra-indi- 
cated, but where the eruption is moist it is useful. In the treatment 
of the chloasma of pregnancy the following prescription is of service : 

R. — Zinci oxidi gr. iij. 

Hydrarg. ammoniat gr. j . 

Olei theobromse ^ijss. 

Olei ricini . . . . . . . gijss. 

Essent. rosee gtt. x. M. 

S. — Apply to the face night and morning. 

In eczema with many vesicles use 

K=. — Pulv. camphorse ^ss. 

Pulv. zinc oxidi 3 iij. 

Glycerini • gtt. xl. 

Adepis benzoinati %y M. 

S. — Apply to the part without other treatment or precede it by powdered bismuth. 

In powdered form zinc oxide is useful in the treatment of intertrigo, 
and in conjunctivitis. With bismuth subnitrate and pepsin it is largely 



2(36 DRUGS. 

used by some practitioners in the treatment of the summer diarrhoea of 
infants or adults. 

In the night-sweats of debility or phthisis oxide of zinc in the fol- 
lowing formula has been highly recommended, but probably depends 
largely for its action on the second ingredient : 

I£.— Zinci oxidi gr. xxx. 

Extract, belladonnse . . . . . gr. iij. M. 

Ft. in pil. no. x. S. — One at night before going to bed. 

Bartholow recommends the oxide of zinc for cases of asthma and 
whooping-cough, given to an adult in the manner just indicated. 



OXYGEN, OXYGEN WATER, HYDROGEN PEROXIDE. 

The gas Oxygen is now widely used in medical and surgical prac- 
tice in three forms, as follows : By the inhalation of the gas 
itself from a cylinder in which it is compressed until 40 gallons 
occupy a very small space ; by drinking oxygen water, which is 
distilled water saturated with the gas ; and finally, by the use of the 
dioxide or peroxide of hydrogen, which is applied locally to diseased 
surfaces. 

Inhalations of oxygen are useful in the second and third stages of 
pneumonia where the patient is about to die from deficient aeration 
of the blood with resulting heart-distention. They are also of value 
in advanced bronchitis, particularly that of old persons, and for the 
resuscitation of persons asphyxiated by coal-gas (Hare and Martin). 
In phthisis aud other exhausting diseases oxygen will allay dyspnoea 
and oppression. 

In the preparation of the solution of oxygen gas the water must be 
distilled so that it may be as free as possible from other gases. The 
bottling should be done under a pressure of 150 to 200 pounds and 
the contents drawn off by means of a tap such as is used in siphons 
or for champagne bottles. Birch, of England, has found that the addi- 
tion of a little nitrous-oxide gas to this water adds piquancy to its 
taste and increases its stimulating effects. The value of this preparation 
is undoubted, and when taken into the body it has proved of the greatest 
service in chronic dyspepsia, persistent vomiting, and headaches both 
digestive and neuralgic. 

In constipation depending upon intestinal atony, oxygen gas is said 
to give relief if it is taken in solution just before going to bed. It is 
hardly necessary to state that the water should be swallowed as soon 
as possible after it is taken out of the bottle which has contained it. 
In some cases where general systemic torpor is present, oxygen water 
taken after each meal, or even more frequently, may be used with 
advantage. One or two tumblerfuls may be taken each time. As a 
substitute for this water the physician may employ peroxide of hydro- 
gen (15-volume) in the proportion of 1 ounce to 2 pints of water. 

The peroxide or dioxide of hydrogen is a colorless, transparent, 



PANCREATIN AND PANCREATIC EXTRACTS. 267 

odorless syrupy fluid, of a specific gravity of 1.452, with a harsh, 
bitter taste, aud is readily soluble in water. It is rarely used in its 
pure form, but should be employed in the strength of what is known 
as the 15-volume solution, or 3 per cent., which strength is the pro- 
portion generally sold as the pure article. As many of the solutions 
are worthless, the following test for its purity has been recommended 
by Wallian : 

Place a few crystals of permanganate of potassium in a test-tube 
and add to it 1 or 2 drachms of the solution. The violence of the result- 
ing effervescence is in direct ratio to its value as a remedial agent and 
to its purity. 

Peroxide of hydrogen is used as an effective application to ulcers of 
the acute and chronic form and upon burns and scalds. When applied 
to surfaces of this character the strength of the solution should be 
varied according to the condition of the part. If the diseased surface 
is very sluggish, the pure 15-volume (3 per cent.) liquid may be used; 
but if the lesion is a recent one, one-half this strength should be em- 
ployed. In pharyngitis and diphtheria a solution of the strength of 
1 part to 7 of water of the 15-volume liquid is useful as a gargle, or 
the undiluted 15-volume liquid may be used on a swab. In the treat- 
ment of sinuses the liquid should be used undiluted, as in ordinary 
irrigation, and the wound dressed antiseptically immediately afterward 
in the ordinary manner, or as desired by the surgeon. Tubercular 
abscesses are said to heal under the influence of peroxide of hydrogen 
with extraordinary rapidity. 

In laryngeal phthisis, ulcerative tonsillitis, ordinary foetid sore-throat, 
and even in pulmonary phthisis, a 2 per cent, solution of the pure 
hydrogen peroxide is of service when used in an atomizer which will 
throw a fine spray. 



PANOREATIN AND PANCREATIC EXTRACTS. 

Under these names a number of firms now sell an extract from the 
pancreatic gland or juice. It contains, or should contain, the four pan- 
creatic ferments : trypsin, which digests proteids (meats, eggs, etc.) ; 
steapsin, which splits up and emulsifies the fats ; amylopsin, which 
has diastatic power — that is, converts starch into sugar ; and finally, 
a milk-curdling ferment. 

A preparation equally useful with the commercial pancreatin may 
be made by the physician in the following manner ; 

Take the pancreas of a pig which has been killed about six hours 
after a full meal, the organ being therefore active, and, after chopping it 
up finely, add to it four times its weight of dilute alcohol and allow it 
to stand for twelve hours. Decant or filter off the alcohol, and give the 
filtrate in the dose of 1 to 2 drachms. Or, better still, as follows : 
Wash and chop up finely a fresh pancreas and allow the gland to 
soak in alcohol (absolute) twenty-four to forty-eight hours. After 
this squeeze out the alcohol and add to the gland ten times its weight 



268 DRUGS. 

of glycerin. This must stand forty-eight hours and then be filtered 
and be used in doses of 30 drops to each glass of milk. (See Pep- 
tonized Foods.) 

Some doubt has been cast upon the usefulness of the employment of 
pancreatin in food, unless this ferment was allowed to act upon the 
aliment before it was swallowed by the patient, on the ground that 
pancreatin is destroyed and rendered inert in the presence of an acid. 
This objection is not a valid one, because food remains in the stomach 
for from fifteen minutes to half an hour before enough gastric juice is 
secreted to interfere with the pancreatic action. It is during this 
preliminary period that the work of the pancreatin is accomplished. 



PAPAIN. 

Papain or Papayotin, or as it is sometimes called Papoid, is a fer- 
ment derived from the juice of Oarica Papaya. This ferment pos- 
sesses the power of changing proteids into peptones in the presence of 
an acid or an alkali, or even in a neutral mixture, thereby differing 
from pepsin and pancreatin. This power, if it exists, is of very great 
value, since the drug would then be useful in all forms of dyspepsia. 
Careful experimentation, however, renders it doubtful as to whether 
papain really can supplant either of the animal ferments named above. 
The dose of papain is from 1 to 8 grains in solution, or better in pill. 
It has the reputation of being capable of causing abortion. 



PARALDEHYDE. 

Paraldehyde is a form of aldehyde used as a soporific and nervous 
sedative, and is a clear, colorless liquid, with an ethereal odor and a 
burning, followed by a cool, taste. It is readily soluble in alcohol, 
moderately so in water, less so in hot water. It possesses the great 
disadvantages of being necessarily given in large dose, and having a 
disagreeable taste and odor. " It is also very apt to disorder the stomach. 
Paraldehyde kills when taken in overdose by respiratory failure, but 
is not so depressant to the heart as is chloral. It requires frequent 
repetition and soon loses its power. The dose is 20 drops to 1 drachm, 
in capsules; or, better still, it may be used, after the formula of Yvon, 
as follows : 



R . — Paraldehyde 



Alcoholis (90 per cent.) 
Tincturse vanillse . 
Aquae . 
Syrupi simplicis . 



1JSS. 



. fgjss. 

. f^ss. 

q. s. ad f^iv. M. 



S. — A dessertspoonful every half-hour until sleep is obtained. 
Paraldehyde is not official. 






pepo. 269 



PAREIRA. 



Pareira, U. S., Pareirce Radix, B. P., is the root of Chondoden- 
dron Tomentosum, a plant of Peru and Brazil, and is used as a diuretic 
of an alterative or stimulant character, and for the relief of chronic 
inflammations of the genito-urinary type in general, such as 'pyelitis, 
eystitis of a subacute type, and similar pathological states. The dose 
of the unofficial infusion is a wineglassful, and the fluid extract 
(Extractum Pareirce Fluidum, U. S.) is given in the dose of a teaspoon- 
ful three times a day. The B. P. preparations of this drug are the 
decoction {Decoctum Pareirce), dose 1 to 2 ounces, the extract (Ex- 
tractum Pareirce), dose 10 to 20 grains, and Extractum Pareirce 
Liquidum, dose 1 to 2 drachms. 



PENTAL. 

Pental is an impure amylene first described in 1844 and used in 
1856. It at once dropped out of notice until a year or two ago, when 
it was brought forward as an anaesthetic for use in minor or brief 
operations. Pental is a colorless liquid, insoluble in water, but readily 
mixed with ether, chloroform, or alcohol. It is very inflammable, 
but not affected by exposure to light and air. 

Physiological Action. — Our knowledge of the physiological action 
of pental is exceedingly limited. Wood and Cerna, from a very in- 
complete and imperfect study, conclude that it is a powerful cardiac 
and respiratory poison. 

Therapeutics. — Pental is to be employed by means of a Juuker 
inhaler if its use is continued for any length of time. If it is to be 
taken for a few minutes, an ordinary chloroform mask or towel may 
be used. The quantity to be used for the production of anaesthesia is 
about 2 to 3 drachms. Pental is an anaesthetic w r hich so far promises 
very little and which will probably be used by a very limited number 
of practitioners, as it possesses no particular advantages over older 
and safer anaesthetics. 

PEPO. 

Pepo, U. 8., Pumpkin Seed, the seed of the ordinary domestic 
pumpkin, is a useful and efficient vermifuge against the tape-worm. 
The seeds are not only efficient, but harmless to the host of the 
worm. The outer coverings of the seeds should be removed, and the 
remaining part rubbed up into an emulsion with water, or into an 
electuary with sugar, the dose of the seed being 2 ounces. This mass 
should be taken on an empty stomach and followed in from one to 
two hours by an active purge. 



270 DRUGS. 



PEPPER. 



Piper, U. S., or Black Pepper (Piper Nigrum, B. P.), is the unripe 
fruit of Piper Nigrum, a vine of India, Java, Borueo and Siam. It 
contains an alkaloid, piperine, which is official. 

Therapeutics. — Black pepper may be used as a counter-irritant or 
internally as a carminative and stimulant to the alimentary canal. 

It may also be used in all cases of atony of the mucous membranes 
of the genito-urinary system, but is contra-indicated whenever acute 
inflammation is present, as in acute gonorrhoea. It may be used in 
the treatment of great flatulence with marked relief. 

Piperine has been used as an antiperiodic with varying success, and 
is given in the dose of 1 to 5 grains. The oleoresin (Oleoresina 
Piperis, U. S.) is given in the dose of \ to 2 drops in laxative pills, to 
prevent griping. A confection (Confectio Piperis) is official in the 
B. P., given in the dose of 1 to 2 drachms. 

PEPPERMINT. 

Mentha Piperita, U. S., is official in the form of the leaves and 
tops. It has an aromatic odor and taste. Locally applied, the oil 
acts as an irritant and local anaesthetic. From this oil is obtained 
menthol, a camphoraceous substance of a hot burning taste, possessing 
marked power as a local anaesthetic. (See next page.) 

Therapeutics. — Peppermint is used very largely as a domestic 
remedy for flatulence and infantile colic. Sometimes the oil is added 
to purgative pills to prevent griping, and it may be employed to cover 
the taste of many medicines which are disagreeable to take. In this 
respect it is used as are all the volatile oils. In the colic of children 
of six months to a year, when it is unusually severe and associated 
with nervous symptoms, the following will be found of value : 

R. — Chloralis ...... gr. xvj. 

Potassii bromidi . . . . gr. xxxij. 

Aq. menth. piperit. . . . . f ^ij. M. 

S. — Teaspoonful in a little warm water every four hours. 

When used in the treatment of neuralgia, oil of peppermint should 
be placed on a piece of linen or muslin rag and applied over the 
affected spot. Care must be taken that it does not blister the skin. 
If, after its removal, the burning is too severe to be borne, a little 
cosmoline or olive oil should be applied. Oil of peppermint is some- 
times placed on cotton and inserted into dental cavities for toothache. 

It is to be remembered that the more menthol is present in the oil 
the more active will it be as an anaesthetic, and that the Chinese oil 
contains more menthol than the American oil. 

Administration. — Peppermint is used in the form of the oil (Oleum 
Menthce Piperitce, U. S. and B. P.), dose 1 to 4 drops ; the spirit 
(Spiritus Menthce Piperitce, U. S. and B. P.), dose 10 to 30 drops • 



PEPSIN. 271 

the water (Aqua Menthce Piperita, U. 8. and B. P.), dose 1 to 
2 drachms, and finally as the Troches (Trochisci Menthce Piperitce 
U. S.) to be he]d in the mouth in indefinite number. Essentia 
Menthce Piperitce, B. P., is given in the dose of 10 to 20 minims. 

Menthol. 

Menthol, or mint stearopten, or as it is sometimes called, Mint Cam- 
phor, is derived chiefly from the essential oil of peppermint. It occurs 
in colorless prismatic crystals, with a strong odor of peppermint. 
Upon it rests much, if not all, of the therapeutic activity of pepper- 
mint. Menthol is slightly soluble in water ; very soluble in alcohol 
and ether. 

Menthol has been used in the vomiting of pregnancy with great 
advantage in hourly dose of a teaspoonful of the following : 

I£. — Menthol. ........ gr. xv. 

Spt. frumenti ....... f ,^vj. 

Syrupi f Jj. 

Menthol has also been used as a carminative and in gastralgia, in the 
dose of from 1 to 2 grains three times a day in pill or in alcoholic 
solution. It is contra-indicated in acute inflammation of the gastric 
mucous membrane. 

As menthol exercises a local anaesthetic effect on the skin as well as on 
mucous membranes, it is used externally over the course of neuralgic 
nerves and in migraine. 

When menthol is used as a depletant on the mucous membrane of 
the throat or nose, it causes a contraction of the local bloodvessels, 
which is not followed by the excessive dilatation produced by cocaine 
when used for similar purposes. In acute coryza its local application 
to the mucous membrane by a spray or dropper is often a source of 
great relief in the saturated solution of about 1 grain to the ounce. 

Another very useful method of applying menthol is by means of a 
simple inhaler consisting of a small glass tube of about J inch in 
diameter and 2 J inches in length. Both ends are closed by a piece of 
gauze and two perforated corks, the menthol being placed in between. 
The air is now drawn through this tube, and being heavily loaded 
with the fumes, clears the nostril and relieves the stuffiness. It is 
not to be simply smelled, but inhaled. Care should be taken that the 
crystals are not allowed to enter the nostril as they are almost cauter- 
ant in power. Sometimes where great excoriation of the alse of the 
nose exists, the too persistent use of the menthol may produce small 
herpetic spots about the nostrils. 



PEPSIN. 

Pepsin, B. P., is the digestive ferment of the gastric juice. That 
sold in the shops is generally derived from the pig, and is prepared 



272 DRUGS. 

by many persons in many ways. Much of the pepsin of the market 
contains more peptone than pepsin, and much mucus and albumin. 
Used with hydrochloric acid in weak solution, it replaces the diges- 
tive action of the stomach. Pepsin containing peptone has the pecu- 
liar musty smell of peptone, and if the peptone is in excess will absorb 
moisture and become sticky on exposure to the air. 

Therapeutics. — Pepsin is a much over-rated remedy for indigestion. 
Pancreatin will always be found more serviceable, and should be 
given either immediately after or one or two hours after meals. 
Pepsin should be used after the food or with it. Hydrochloric acid 
should always be given, as its presence converts any pepsinogen in 
the gastric tubules into pepsin. Pepsin is official in the TJ. 8. P. as 
Pepsinum Saccharatum, dose 20 to 30 grains, to be of any service. 
It is a weak and almost useless preparation, made up chiefly of milk 
sugar. Liquor Pepsini, TJ. 8., is given in the dose of 2 drachms. 
Pure pepsin should be given in 5 to 15-grain doses. 



PERMANGANATE OF POTASSIUM. 

Potassii Permanganas, TJ. 8. and B. P., is a salt of a dark pur- 
plish-red color, appearing in small crystals and readily soluble in 
water. In the presence of moisture it rapidly gives up the oxygen 
which it contains and becomes the binoxide of manganese. 

By reason of this oxidizing power the permanganate of potassium 
is largely used as an antiseptic and deodorant. It should not be 
employed as a disinfectant, because its action is too fleeting. 

Permanganate of Potassium (Potassii Permanganas, TJ. 8. and 
B. P.) is given in the same dose for the same conditions as the 
binoxide of manganese, but is much less efficacious. It is also very 
apt to irritate the stomach. 

It is thought to be useful in dyspepsia, flatulence, lithcemia, and 
obesity, and in the former states is certainly of service, being a 
destroyer of the abnormal products by oxidation. Owing to this or 
other reasons, it has been asserted by Weir Mitchell and Reichert to 
be the most efficient antidote to snake venom, if placed in the wound 
before the poison is absorbed. It should be injected hypodermically 
about the bite. Owing to its rapid absorption of oxygen it acts as an 
antiseptic, and may be used in the washing of wounds, ulcers, and 
sores, and as a lotion in the form of a gargle, or on a swab in diph- 
theria and scarlet fever. The solution used should be from 20 to 60 
grains to the pint ; the former if used on mucous membranes, the latter 
for sores and wounds. In foetid rhinitis and otitis media permanganate 
solution is useful as a wash. When given in solution permanganate 
of potassium should be dissolved in distilled water, and it should never 
be mixed in a mortar with any organic matter, as it will explode. 
The drug has been used for the relief of amenorrhoea in the same 
manner as the binoxide of manganese. A solution (Liquor Potassii 
Permanganas) is official in the B. P. 



PHENACETINE OR ACETPHE NETIDINE. 273 



PETROLATUM. 

Under the name of Petrolatum, U. S., or Unguentum Petrolei, is 
sold a semi-solid substance derived from coal-tar and sometimes called 
Cosmoline or Vaseline. 

Owing to its soothing powers and non- rancidity, it is used as an 
emollient dressing in sores and skin affections. It has no value ex- 
cept as a protective, and may be given in capsules in cases of gastro- 
intestinal irritation in any quantity as a soothing treatment. It does 
not affect the passages from the bowels and is not absorbed, although 
assertions to the contrary have been made. 

Cosmoline is a useful vehicle for medicines for the skin. Under 
the name of fluid or liquid cosmoline a fluid form is sold, and is used 
in the form of a spray in the treatment of rhinitis and after irritant 
applications to the nasal cavities. 



PHENACETINE, or AOETPHENETIDINE. 

This is another of the coal-tar products introduced several years 
ago as an antipyretic of the same character as antipyrine, and while 
more apt to disintegrate the blood than the latter drug when given in 
large amounts, is not very dangerous, because its influence upon other 
vital parts is not severe. 

When this drug is carelessly made an impure product is the result, 
which produces irritation of the kidneys and, in consequence, causes 
grave complications. Reuter states that the impurity may be dis- 
covered by placing a small amount of chloral hydrate in a test-tube, 
melting it at the temperature just sufficient to liquefy it, and then adding 
the suspected sample of phenacetine in the proportion of one-fifth. If 
the phenacetine is impure it will become purple, then red, and finally 
blue. 

Physiological Action. — Unfortunately our knowledge of the phy- 
siological action of phenacetine upon the nervous system is not as 
thorough as is desirable. We know, however, that it is a distinct 
nervous sedative, and that it acts particularly on the spinal cord in its 
sensory paths. 

Upon the circulation the drug has little or no effect, unless given 
in doses far above those generally employed, or continued in over- 
dose for some time. The blood after the ingestion of these doses be- 
comes dark and blackish from the formation of methsemoglobin, and 
the urine becomes dark yellow and reacts with Fehling's solution. 
Upon normal bodily heat and the heat of fever the drug exerts a 
depressing effect, decreasing the production and dissipation of heat. 

Therapeutics. — Our knowledge concerning the influence of phen- 
acetine upon the human body in disease may be divided into two 
separate parts, in much the same manner that we divided antipyrine — 
namely, its uses as an antipyretic and as an analgesic. 

18 



274 DRUGS. 

Like the other members of the antipyretic group which are blessed 
with this double action, its antipyretic influences were first observed, 
and shall therefore first be spoken of 

The employment of this drug in medicine was first attempted by 
Hinsberg and Kast, who from the very first spoke of it in the highest 
terms of praise. They found that it seldom, if ever, caused serious 
untoward effects, and that its power over fever, in the dose of from 3 
to 8 grains, was quite extraordinary. Very shortly after the paper of 
these writers appeared, Kohler published the report of its use in some 
fifty cases in the clinic of Bamberger of Vienna, the febrile affections 
being tuberculosis, pneumonia, typhoid fever, pleurisy, and several 
other diseases of like character. He found, as have most of his suc- 
cessors, that the fall of fever does not occur for nearly half an hour 
after the dose is taken, aud that the stage of apyrexia continues for 
from four to eight hours afterward. 

As a general rule, sweating was not noted as being present to any 
great extent, but in phthisis and advanced typhoid fever there can be 
no doubt that chilliness and an abnormal fall of temperature may 
come on. Cyanosis and vomiting did not occur in a single one of 
Kohler's cases'. In a very instructive case of pneumonia due to septic 
infection in a patient of twenty years, phenacetine not only lowered 
the fever, but in addition decreased, to a large extent, the blood in 
the urine, and did not in the slightest degree influence the kidneys 
unfavorably. That the drug has power is evidenced by the fact that 
Kohler used it only when the temperature reached as high as 103°, 
104°, or 105° F., and in these cases the temperature fell not less than 
from three to five degrees. 

It is a very important fact to be remembered that morning doses 
of phenacetine seldom have as powerful an influence as evening doses. 
Two morning doses are only equal to one evening dose in most cases, 
and it would seem better in phthisis to give the drug about noon to 
prevent the evening exacerbation of temperature than to resort to it at 
a time nearer the pyrexial period. 

The conclusions of Kohler have been confirmed by Hoppe in a 
long series of studies, and this writer also points out the deleterious 
excess of apyrexia which sometimes comes on in debilitated cases of 
phthisis. 

One of the advantages of having several drugs belonging to one 
class is the benefit often derived from the use of one where another 
has failed. Thus Hueber found that in several instances phenacetine 
was successful where antipyrine had not acted, and believes it to be 
the more powerful drug of the two — a conclusion also reached by 
Heusner, who thinks that 15 grains of phenacetine are equal to half 
as much antifebrin and to 30 grains of antipyrine. Lepine, who has 
studied with so much care the other antipyretics, also believes it to 
be superior to them all, and in this Guttman is largely of the same 
opinion. 

These conclusions are, in the author's belief, far too favorable, for 
while he has found the drug to possess powerful antipyretic activity 



PHENOCOLL. 275 

and to be useful in nearly all the fevers where antipyrine can be em- 
ployed, he does not look upon it with the same degree of confidence 
that he does the latter drug, when anxious to reduce a fever which 
seems dangerous and worthy of rapid and certain reduction ; neither 
does he believe it to be as safe as antipyrine. 

Upon the nervous system phenacetine acts as an anti-neuralgic, is 
of service in migraine and ordinary headache from eye-strain, in tabes 
dorsalis, in intercostal neuralgia, and in rheumatism. Sometimes it 
cures these troubles when antipyrine fails. Altogether we may con- 
sider phenacetine a rival of antipyrine in the power to relieve pain. 

For neuralgia the following prescription may be ordered : 

R . — Phenacetine gr. x. 

Caffeinae citratis . . . . . . gr. v. 

Sacchar. lactis gr. xx. M. 

Ft. in chart, no. v. S. — One powder every two hours while pain lasts. 

In rheumatism and in the lumbar or muscular pains of influenza a 
powder or pill of 4 grains of phenacetine and 5 grains of salol given 
three or four times a day is most efficient. 



PHENOCOLL. 

Phenocoll is a compound closely allied to phenacetine. It is always 
used in the form of the hydrochloride of phenocoll, which occurs in a 
fine, white powder, quite soluble in water and forming a neutral solu- 
tion. It is incompatible with alkalies. It is used as an antipyretic. 

Physiological Action. — A number of studies of the action of pheno- 
coll hydrochloride upon the animal organism have been made by 
Kobert and Von Mering, in Europe, and by Wood and Cerna, and Ott, 
in America. These investigators have found that it separates itself 
from most of the coal-tar antipyretics in that it has little effect on the 
red blood-corpuscles. It does not cause as great a sweat when the 
fever falls as do its near antipyretic relations. Von Mering has shown 
that phenocoll has little lethal power, but Ott asserts that it kills by 
failure of respiration and causes paraplegia, cyanosis, and depression 
of the heart in poisonous close. 

Therapeutics. — Whatever advantages further clinical experience will 
show this drug to possess over its older fellows in the antipyretic field, 
it can never be widely used as a remedy for fever, since no drug is now 
widely employed for this effect except in a limited class of cases As 
pointed out in the treatment of Fever, antipyretic drugs are of little 
value as compared to bathing. Phenocoll may be given for the same 
purposes and under the same circumstances in the presence of fever as 
can antipyrine or aeetanilide, but like these drugs is contra-indicated 
in advanced exhausting diseases such as consumption. A number of 
clinicians have tried phenocoll hydrochloride for the relief of rheu- 
matism and to remove neuralgic pain, with asserted success. As yet 
it has not been used largely enough to insure its continuance as a 



276 DRUGS. 

remedy of positive value. The dose of phenocoll Irydrochloride is 5 
to 8 grains two to five times a day. It is best given in capsule. 



PHOSPHATE OF SODIUM. 

Sodii Phosphas, U. S. and B. P., is a preparation which is rarely, if 
ever, used to supplant phosphorus, as it has an entirely different effect. 
It is particularly useful in bottle-fed children, who continually alternate 
between diarrhoea and constipation, and is also useful in rickets. It 
should be added to each bottle of milk in the dose of 2 to 4 grains. 
Phosphate of sodium is slightly laxative. Bartholow believes phos- 
phate of sodium to be the best remedy that we have in hepatic cir- 
rhosis and jaundice. 

PHOSPHIDE OF ZINC. 

Zinci Phosphidum, U. S., is often used in place of phosphorus, 
owing to its greater stability and readiness of administration. The 
dose is ^q to T \- of a grain three times a day. It is used in gelatin- 
coated pills. 

PHOSPHORIC ACID. 

The pure acid is very rarely employed in medicine, but when given 
is used in 2 to 8-drop doses. In the form of dilute phosphoric acid 
(Acidum Phosphoricum Diluium, U. 8. and B. P.) it is widely em- 
ployed in the dose of 20 drops to 1 drachm as a tonic and gastric stim- 
ulant. It is not a food to the nervous system, does not resemble phos- 
phorus in its physiological action, and is not to be employed in its 
place. It does good in nervous exhaustion simply by stimulating the 
stomach and thereby aiding the organ in the digestion of food. 

Many cases of wretched ness or headache due to an excess of uric 
acid in the blood are relieved by this drug if the phosphate of sodium 
or calcium be used, since these substances cause the disappearance of 
the acid from the blood, not by causing its elimination, but by causing 
its deposit in the tissues in the form of urates. The use of these so- 
called acid phosphates is harmful in gouty or rheumatic persons. 



PHOSPHORUS. 

Phosphorus, U. S. and B. P., is a non-metallic element, generally 
obtained from bones, and is very soluble in oils, less so in ether and 
alcohol. Its odor is very characteristic and peculiar. When placed 
in a dark room after exposure to light it is luminous, and if exposed 
to the air will ignite. It should be kept in tightly stoppered bottles 
under water. Very commonly it is contaminated by arsenic and sul- 
phur. 



PHOSPHORUS. 277 

Physiological Action. — Phosphorus is found in large amount, com- 
paratively speaking, in the bones and in the nervous system, and is a 
stimulant to the growth of both. It acts, therefore, as a direct tonic 
to nervous tissue and is a producer of bone. Upon tissue-waste the 
drug acts as a depressant, thereby preserving the body, as it decreases 
the elimination of urea and diminishes the quantity of carbonic oxide 
exhaled. 

Upon the growth of bones phosphorus has a most remarkable in- 
fluence, causing, when it is given to young animals, great increase in 
the size of these parts. The first change noted is an enlargement 
which consists in a jelly-like mass containing little or no bone salts, 
and this is finally converted into a very hard material which may fill 
the entire canal in the centre of the bone. Kissel has stated that this 
does not occur, but his results must be doubted in view of the thorough 
studies of Wagner. 

Acute and Chronic Poisoning. — When phosphorus is taken in poi- 
sonous dose, often from the ends of matches, no symptoms may come 
on for eight or ten hours. At the end of that time the peculiar taste 
of phosphorus may be noted in the mouth, the breath is heavily 
laden with its color, and burning pain in the oesophagus, stomach, and 
abdomen ensues. Vomiting and purging now assert themselves, and 
both the matters which are vomited and those which are passed from 
the bowels may be luminous in the dark owing to the presence of 
phosphorus. The vomit at first consists of food, then mucus, then bile, 
and then perhaps blood. All the symptoms of a mild gastro-enteritis 
may develop, but it is to be noted that constipation of an obstinate 
type may replace the purging. Very soon the liver increases in size 
and gives rise to general hypochondriac pain and tenderness as well 
as local swelling. At the end of twenty-four hours, or, perhaps, 
after the second day, a cessation in the symptoms occurs, and, if the 
physician be not on his guard, this will lead him to a hopeful prog- 
nosis, but in the course of a few hours jaundice begins in the con- 
junctiva and then extends over the entire body. With the onset of 
jaundice the vomiting and pain return with renewed vigor. The 
matters vomited are often the color of " coffee grounds,' 7 due to 
exuded and altered blood. The bowels are absolutely confined, or 
the few hard masses passed are white and clay-like because of the 
absence of biliary coloring matter. There is no bile in the vomit in 
this stage because the hepatic ducts have been closed by the inflam- 
mation which has been produced in the liver. Later, nervous symp- 
toms ensue. Muscular twitchings, headache, vertigo, wild delirium, 
erotic convulsions, and finally unconsciousness aud death occur. 
Sometimes the convulsions occur just before dissolution. Even if the 
patient survives the acute stage of the poisoning he generally dies of 
the changes produced in his organism, which consist in widespread 
fatty degeneration. These fatty changes occur even in the acute period 
of the poisoning. Atrophy of the liver, destruction of the gastric 
tubules, pancreatic involvement and kidney degenerations aid in pro- 
ducing the ultimately fatal results. 



278 DRUGS. 

During the poisoning by phosphorus the urine is scanty and per- 
haps albuminous, and is peculiar because of the unusual substances 
which are found in it. The most unusual of these is sarco-lactic acid, 
which results from the breaking down of the muscular tissues. Leucin 
and tyrosin are also found, and tube-casts with fatty globules in them, 
are seen. Free fat globules may also occur. Bile acids and bile col- 
oring matter are found in large amount, and the urine is generally 
dark-colored for this reason. As phosphorus is eliminated as hypo- 
phosphoric acid, this substance is also present. 

The symptoms of phosphorus poisoning may so closely resemble 
those of acute yellow atrophy of the liver as to make a differential 
diagnosis impossible unless some evidence of the presence of phos- 
phorus is obtainable. 

In chronic poisoning by phosphorus, when, by the inhalation of its 
fumes systemic changes occur, the most common lesion is necrosis of 
the lower jaw, which may be widespread or limited. It never occurs 
in those who have no solution of continuity in the teeth or gums, 
and for this reason it is necessary that the employes in match facto- 
ries should have their teeth constantly attended to. It is said that 
pans containing turpentine when set around the room will protect the 
workmen, but this is the merest fetich. 

Treatment of Acute Poisoning. — The antidote to phosphorus 
is generally taught to be the sulphate of copper, which will act as an 
emetic if given in excess, but recent studies made by Thornton in the 
laboratory of Jefferson Medical College prove that it is as dangerous a 
poison as the phosphorus. Peroxide of hydrogen and permanganate 
of potassium are probably the best antidotes. Oil of turpentine, in 
America, is not only valueless as an antidote, but harmful, for only 
old, ozonized, French oil of turpentine is antidotal in its influence. 
As phosphorus is soluble in oils, we simply aid in its absorption if any 
such substances are given. 

Therapeutics. — Owing to its influence on the development of bone, 
phosphorus is very useful in rhachitis and osteomalacia. It is also 
useful in the sweats of general or nervous debility and in nervous ex- 
haustion, and in some cases of melancholia depending upon overwork. 
In the course of prolonged exhausting diseases, as typhoid fever or 
typhoid pneumonia, the drug is of service if the nervous system seems 
to be particularly affected, and in convalescence it is of great service 
to aid in building up the shattered forces of a patient. 

In the sequelae of acute and chronic alcoholism and in morphiomania 
it is often of service. Phosphorus is also employed in sexual exhaus- 
tion or abuse. In boils and carbuncles and similar disorders phos- 
phorus is very useful, particulary so in acne indurata. In pneumonia 
some physicians use minute doses with the belief that it aids in the 
production of resolution, one of the most enthusiastic of these being 
Dr. Boardman Reed. 

In the neuralgia from nerve-depression, and in cerebral softening 
and meningitis of a chronic type, phosphorus often does good. 

The dose of phosphorus is t ^-q to -^ of a grain in pill form 



PHYSOSTIGMA. 279 

(Pilula Phosphori, U. S. and B. P.), but it may be gradually pushed 
to yV °f a g ram ^ urgently needed. Phosphorated oil {Oleum 
Phosphoratum, U. S. and B. P.) is given iu the dose of 1 to 5 
minims. 

The beginning dose of phosphorus should not be above t -J-q of a 
grain for tear of some idiosyncrasy. 



PHYSOSTIGMA. 

Physostigma, U. S., Physostigmatis Semen, B. P., is a seed derived 
from Physostigma Venenosum, a tree of West Africa, often called 
Calabar Bean. It contains two alkaloids, eserine or physostigmine, 
and calabarine. The former is the most important from a medical 
point of view. 

Physiological Action. — Calabar bean is a general paralyzant, but if 
the alkaloid calabarine be in excess it may be a convulsant. 

Nervous System. — On the spinal cord in poisonous dose, this 
drug acts as a direct depressant poison, particularly affecting the 
motor tracts. On the motor nerve it exerts no influence at all unless 
given in large toxic doses, when it depresses their peripheral ends. 
The sensory nerves generally escape, but sometimes even they are 
involved. On the voluntary muscles the drug in these doses causes 
twitchings, due to a direct influence over their fibres. In all medi- 
cinal doses the drug is a stimulant to unstriped muscular fibre. 

Circulation. — Calabar bean causes comparatively little circu- 
latory change, but it produces a rise of arterial pressure, based largely 
upon a direct stimulation of the heart, and slows the pulse by peri- 
pheral stimulation of the cardiac inhibitory nerves. 

Respiration. — In moderate amount Calabar bean causes no in- 
terference with the respiration, but in poisonous dose produces death 
by paralysis of the respiratory centre. 

Pupil. — Physostigma causes myosis or contraction of the pupil 
by stimulation of the oculo-motor nerves peripherally, and by de- 
pression of the sympathetic fibres. It decreases intra-ocular tension. 

Alimentary Tract. — Physostigma is a stimulant to intestinal 
peristalsis, increasing the muscular activity in the walls of the gut, 
and acting as a tonic to these fibres. 

Poisoning. — Calabar bean is used by the African as an " ordeal 
bean," to determine whether a person is or is not guilty of a crime. 
If an individual eats it and survives he is guiltless, but if he dies he 
is guilty, according to this rather fatalist belief. If he does survive 
it is generally by reason of the calabarine producing vomiting and 
purging, and so ridding the patient's stomach of the poison before it 
is absorbed. 

Poisonous doses cause muscular tremors, followed by complete 
muscular relaxation. The pupils contract, the respirations become 
slow and irregular, and all reflex action fails. Vomiting or purging 
may or may not occur. 



280 DRUGS. 

Treatment of Poisoning. — This consists in the use of atropine, 
which is the physiological antidote, in the application of heat to the 
body, and the use of respiratory and cardiac stimulants, such as digi- 
talis, alcohol or ammonia. 

Therapeutics. — Calabar bean is employed in many affections, such 
as trismus neonatorum, tetanus, and other spasms, with only moderately 
good results. It is, however, of value in atony of the bladder and 
intestines, and in catarrh of the bowels. The author has used it with 
great success in cases of gastric and intestinal dilatation. 

In bronchial asthma and emphysema it will aid in the expulsion of 
the mucus by its influence over the muscular fibres in the walls of the 
air-tubes. It is also useful in purgative pills. (See Constipation.) 

Administration. — Physostigma is used in the form of the extract 
(Extractum Physostigmatis, U. S. and B. P.) in the dose of J of a grain, 
which may be readily increased to J of a grain. 

The tincture (Tinctura Physostigmatis, U. 8.) is given in the dose of 
10 to 40 drops. 

Eserine (Physostigmina, B. P.) may be used in the dose of -g 1 -^ of a 
grain three times a day. In the eye, the strength of 1 to 2 grains to 
the ounce of water, eserine is used in the treatment of corneal ulcera- 
tions, and for the relief of glaucomatous states with high intra-ocular 
tension. If, for any reason, atropine mydriasis is to be rapidly over- 
come, eserine is to be used, but it is not so powerful as atropine, and 
it will require larger amounts of the solution to produce contraction 
than it took of atropine to cause mydriasis. Lamellae Physostigminm, 
B. P., each contain y-^oo" °^ a grain °f physostigmine. Two salts of 
eserine or physostigmine are now on the market, namely, the sulphate 
and the salicylate. The former is much more soluble and is generally 
to be employed. The salicylate is largely used nevertheless by oph- 
thalmologists. The dose of both salts- is t -J~q to -j-J-q- of a grain. 



PILOCARPUS. 

Pilocarpus, U. S., Jaborandi, B. P., is derived from the South 
American tree, Pilocarpus Pennatifolius. It contains two alkaloids 
known as pilocarpine and jaborine, a volatile oil, and other minor 
constituents. The alkaloid pilocarpine is non-crystallizable and occurs 
as a soft mass. The salts of pilocarpine are, however, crystallizable. 

Physiological Action. — When jaborandi is taken in medicinal dose 
by a healthy man it causes a deep flushing of the face and neck, 
followed by the outbreak of a profuse sweat, which, though begin- 
ning in these regions, rapidly spreads over the entire body. Accom- 
panying the sweat the salivation is often exceedingly profuse, so that 
saliva dribbles from the mouth. Nausea frequently comes on, and 
severe vomiting may appear in susceptible persons either during or 
after the sweating. On the contrary, some individuals are singularly 
insusceptible to the influence of pilocarpus, and this is particularly so 
with children, according to Ringer, who will often take as much as 



PILOCARPUS. 281 

60 grains of the crude drug before they perspire. Some adults also 
refuse to yield to its influence. 1 The sweat lasts from three to five 
hours. 

Nervous System. — Moderate doses have no effect on this part of 
the body, but poisonous amounts cause in the frog tetanic reflex con- 
vulsions, and finally paralysis, the latter being due to depression of the 
muscles and spinal centres. The nerves escape. Medicinal doses in 
man exercise no effect over the nerves. 

Circulation. — In large doses there is no doubt that jaborandi 
acts as a cardiac depressant rather than as a stimulant, and while there 
may be no evidence of an experimental character pointing to such, a 
conclusion, the fact exists in practical medicine. The drug causes, 
in the lower animals, a slow pulse and increased arterial pressure, 
in moderate quantities, the first change being due to an action on 
the inhibitory centres in the heart or the peripheral vagi. Ringer, on 
the other hand, has proved that it slows the beat of the ventricles in 
the frog, when they are separated from these centres, and believes that 
the drug acts directly on the motor centres of the heart-muscle and the 
muscle itself. In man the drug does not slow the pulse but quickens 
it very markedly, often as much as forty to fifty beats per minute. The 
rise of arterial pressure seen in the animal is often replaced by a fall of 
pressure in man, and though the pulse in animals is generally made 
stronger from its use, in man it is generally weaker. 

Temperature. — Jaborandi lowers bodily temperature to a consid- 
erable degree, probably by the dilatation of the peripheral capillaries 
and the profuse sweat which it produces. This fall is sometimes pre- 
ceded by a brief rise. 

Kidney and Tissue-waste. — Upon the kidneys jaborandi acts 
very slightly or very strongly, according to the dose that is given. 
Large doses, which produce a profuse sweat, naturally decrease the 
urinary secretion, and small ones undoubtedly increase it. Upon the 
tissue-changes in the body under pilocarpine no researches have been 
made, but it is an undoubted fact that the excretion of urea is largely 
increased in disease under the influence of this drug. 

Eye. — Jaborandi contracts the pupil by acting peripherally on the 
nerves of the iris. 

Skin. — The amount of sweat caused by the drug in man may equal 
as much as a pint, and it is, generally, first acid, from the secretions 
of the sebaceous glands ; then neutral ; and finally, alkaline. The 
sweating is not due to vasomotor palsy, but to stimulation of the 
ends of the nerves supplying the glands and of the sweat-glands them- 
selves. Sometimes excessive salivary secretion supplants that of the 
skin . 

Pilocarpine increases the gastric, salivary, and lachrymal secretions 
as well as that of the skin and kidneys. It also seems to have con- 
siderable influence over the secretion of milk. 

1 The writer has reported a case (see Idiosyncrasy, page 25) where a woman of 
thirty received three-quarters of a grain of the muriate of pilocarpine hypodermi- 
cally in half an hour without any effect. 



282 DRUGS, 

Therapeutics. — Jaborandi or, better still, its alkaloid, pilocarpine, 
is of great value for the relief of dropsy of the renal type. In that 
due to cardiac disease it is generally too depressing, and the author 
knows of a case in which a fatal result followed its use under these 
circumstances. It may be used to abort an attack or paroxysm of 
malarial fever, but because of its depressant influence should never be 
employed in asthenic fevers, such as typhoid fever. In pleurisy with 
effusion it may be used, but more efficient remedies are elaterium or 
salines given in concentrated form and at the proper time of the day. 
(See Magnesium Sulphate and Dropsy.) Mitkowski has tried pilocar- 
pine in catarrhal jaundice of a persistent type with great benefit, in the 
hypodermic dose of \ grain every other day for three weeks. In urcemio 
poisoning pilocarpine is the most efficient and rapidly acting remedy 
that we have, and when used in Bright' s disease it is of value in several 
ways : first, by removing the straiu on the kidneys ; second, by elimi- 
nating the ursemic poison ; and third, by decreasing the inflammatory 
action in the kidneys, if they are acutely inflamed, by lowering the 
blood-pressure which, it will be remembered, is the more constant effect 
of the drug in man. The drug in small doses certainly increases renal 
activity. The hypodermic dose as a renal stimulant should be about 
3T ^° To" °f a grain. I n some forms of prof use sweating, such as come 
on at night in general debility, pilocarpine, if given hypodermically 
or by the mouth about two hours before the sweat in the dose of fa of 
a grain, is often useful, even where atropine fails. Pilocarpine cer- 
tainly has a decided effect in encouraging the growth of hair, and ap- 
plied locally will often do good in partial baldness. If too much 
pilocarpine is used it is apt to cause the development of small pustules 
about the hair follicles. Bartholow recommends the following appli- 
cation for baldness : 

I£. — Extract, pilocarpi fluid. .... f ,^j. 

Tincturse cantharidis f 3 ss. 

Liniment, saponis . . . . . f ^jss. M. 

Antagonisms of Jaborandi. — Jaborandi is a physiological autidote 
to atropine and to agariciu. Four times the dose of pilocarpine must 
be used to equal a dose of atropine. 

Administration. — The dose of jaborandi is 40 grains, used in the 
form of the powdered leaves in infusion. The fluid extract (Ex- 
traclum Pilocarpi Pluidum, U. 8.) should be used in the dose of 30 
drops to 1 drachm. Pilocarpine is far superior to jaborandi, in that 
it does not so often produce nausea and vomiting. It is used in the 
form of the hydrochlorate (Pilocarpino3 Hydrochloras, U. S.) in the 
dose of from J to J of a grain hypodermically or \ to J of a grain by 
the mouth. 

The preparations of the B. P. are, the extract (Extractum Jabo- 
randi) dose 2 to 10 grains ; the infusion (Infusum Jaborandi), dose 1 
to 2 fluidouuces ; the tincture (Tinctura Jaborandi), dose J to J fluid- 
ounce ; and the nitrate of pilocarpine (Pilocarpine Nitras), dose fa to 
J grain. 



PISCIDIA ERYTHRIJSTA. 283 

Clinical reports show that pilocarpine in small doses is a very good 
remedy in tobacco and alcoholic amblyopia, and Da Costa has recently 
highly recommended the hypodermic injection of pilocarpine around 
the border-line of erysipelatous inflammation as a preventive and cura- 
tive measure in the early stages of this disease. 



PIPERAZINE. 

This is a substance the chemical formula of which is C 4 H 10 N 2 , 
which has been recently introduced into medicine for the treating of 
the uric acid diathesis. It is not stable, and when exposed to the air 
attracts water and carbonic acid. Aqueous solutions are decidedly 
alkaline, but do not have any distinct taste. 

Piperazine is peculiar in its power to dissolve uric acid, dissolving 
twelve times as much as will carbonate of lithium, while it is also 
entirely soluble in water, which lithium is not. When taken into the 
body the drug is partly oxidized and partly eliminated unchanged. 
Theoretically piperazine, when taken into the body, forms with uric 
acid a urate of piperazine, which is soluble and readily eliminated. 
As yet no competent experiments have been made to determine this 
point, but repeated clinical observation has shown that the adminis- 
tration of the drug causes an increase in the amount of urea in the 
urine with a decrease in the uric acid, indicating that under its influ- 
ence oxidation is more complete. 

Therapeutics. — Piperazine is used for the purpose of preventing the 
formation of renal and vesical calculi in the uric acid diathesis, and 
also in cases where the excess of uric acid in the urine tends to produce 
irritation of the bladder. Similarly its action has been found of value 
in treating vesical irritation due to this cause by washing out the 
bladder with a solution of piperazine of the strength of one per cent. 
Piperazine may also be injected into uric acid deposits about the body 
or applied to the broken-down surfaces of these deposits in 1 per cent, 
solution. 

The dose of piperazine is 15 grains in twenty-four hours. It is best 
given by dissolving this amount of the drug in one pint of water, and 
directing the patient to take a wineglassful of the solution frequently 
through the clay. Owing to the effect upon the drug of exposure to 
air it cannot be given in pill or powders, and should be freshly mixed 
each day. The writer has failed to obtain any results from the use of 
this drug in his practice. 



PISCIDIA ERYTHRINA. 

Piscidia Erythrina is a drug which is stated to possess marked nar- 
cotic and pain-relieving properties. It is sometimes called Jamaica 
dogwood. Its powers as a soporific and analgesic do not compare with 
those of opium, but it is stated to be devoid of the unpleasant after-effects 



284 DRUGS. 

of the latter drug. Further studies concerning its effects on the animal 
economy are needed. According to Dr. Isaac Ott and Dr. Nagle the 
drug has little or.no effect on the motor and sensory nerves, and its 
dominant effect on the circulation is to increase arterial pressure through 
stimulation of the vasomotor system. The indications which have 
been met best by piscidia are dysmenorrhea due to irregular flow and 
spasm of the uterine cervix and fundus, to allay nervous irritability, 
and to relieve pain or insomnia due to pain. 

Administration. — The dose of the fluid extract of piscidia erythrina 
is J to 2 drachms ; of the solid extract 2 to 10 grains. The alkaloid 
piscidine is not known to represent all the properties of the drug and 
is not used in medicine. 

PITCH. 

Pix is a resinous exudation derived from several species of pines, 
firs, and spruces, and is, in one of its forms, obtained by the evapora- 
tion of wood-tar. It is used for various purposes, according to its 
derivation. Burgundy Pitch (Pix Burgundica, U. 8. and B. P.) is 
derived from Norway spruce, or Abies Excelsa, a plant of Europe and 
Asia. It softens and melts at the temperature of the body, and is 
useful in plasters. In muscular rheumatism and in chronic bronchitis 
pitch is a mild and fairly useful local remedy. In the form of the 
plaster (Emplastrum Picis Burgundies, U. 8. and B. P.) and in the 
form of warming plaster (Emplastrum Picis cum Cantharide, U. 8.) it 
is employed for the relief of deep-seated sprains and bruises, and acts 
as a mild counter-irritant, which may blister a tender skin. Canada 
Pitch (Pix Canadensis, U. S. and B. P.) is obtained from the hemlock 
spruce of Canada and the United States, and is used for the same pur- 
poses as Burgundy pitch. The Canada-pitch plaster (Emplastrum 
Picis Canadensis, U. S.) is employed for the same conditions as the 
plaster of Burgundy pitch. 

Tar. 

Under the name of Pix Liquida, U. 8. and B. P., or Tar, we have 
an empyreumatic oleoresin obtained by destructive distillation from 
Pinus Palustrus and other varieties of pine. It is a thick, dark oil, 
slightly soluble in water, and soluble in alcohol, oils, and solutions of 
potassa and soda. By distillation of tar we obtain oil of tar ( Oleum 
Picis Liquidm, U. 8.), which is sometimes used by inhalations from 
an atomizer in bronchitis, but is not a particularly useful application. 
It should be diluted with some other oil or with fluid cosmoline. Tar 
itself is used in subacute and chronic bronchitis in 2-grain pills, and as 
a remedy for gastro-intestinal catarrh. Externally, it is used in 
psoriasis and other skin diseases needing stimulation. In obstinate 
diarrhoea Wood has highly recommended a mixture of tar made as 
follows : Add a pint of tar to a gallon of lime-water, and allow this 
solution to stand one week, stirring it every few hours. Decant the 
clear liquid and percolate it through powdered wild-cherry bark, 



PODOPHYLLUM. 285 

allowing one ounce of the bark to be present for each pint passed 
through it. The dose is a wineglassful. 

In chronic bronchitis tar- water is largely used, as a popular remedy, 
in Europe and England. Tar- water is made by shaking 1 part of tar 
with 4 parts of water several times during twenty-four hours, decant- 
ing and filtering. The dose is from 1 to 2 pints a day as a drink. It 
at first increases the expectoration, but finally decreases it. 4 

Syrup of Tar (8yrupus Picis Liquidw, U. 8.) is simply sweetened 
tar- water. 

In skin diseases of the dry, scaly sort, tar ointment ( Unguentum 
Picis Liquidce, U. 8. and B. P.), equal parts of tar and suet, is very 
useful if frequently applied. It should not be used on the face, as it 
will stain the skin. 

Wine of Tar ( Vinum Picis) is made by adding together tar 1 pint, 
glycerin, white winje, and honey, of each half a pint, dilute acetic acid 
1 ounce, and 3 quarts of boiling water, and shaking constantly at a 
temperature of 160° Fahr. for several hours. It is then set aside to 
stand for some days and repeatedly filtered or strained through mus- 
lin. The dose is 1 to 4 ounces. It may be used instead of tar-water 
or tar-syrup. 

PODOPHYLLUM. 

Podophyllum y U. S., Podophylli Phizoma, B. P., May Apple or 
Mandrake, is the rhizome and small roots of Podophyllum Peltatum, 
a plant of the United States and Canada. Podophyllum contains a 
resin, podophylli n. 

Therapeutics. — Podophyllum is the slowest-acting purge in the 
Pharmacopoeia. In small doses it is laxative, but is purgative and 
almost drastic in larger amounts. In overdose it may produce gastro- 
enteritis. The drug particularly excites the flow of bile, and is used 
as a cholagogue. It is best given when the stools are dark in color, 
calomel being indicated when they are light. In children one or 
two months old who have hard, stony stools, podophyllin is the best 
remedy. The dose should be given by dissolving a grain of the 
resin in a drachm of alcohol and using 2 drops of this on sugar 
once or tw r ice a day. In children who suffer from diarrhma in which 
the passages consist almost entirely of water, which have a peculiar 
musty smell or a mouse-odor, podophyllin in the dose of -fo to -^ of 
a grain is of service, seeming to control the passages and make them 
normal. This treatment will often succeed when all else fails. This 
statement is also true in regard to the chronic diarrheas of adults, 
though the drug should be given in somewhat larger amounts in such 
cases. Podophyllin will also check vomiting in these doses in some 
instances, provided that the stomach is depressed and the liver is 
torpid. It should not be employed if the vomiting is due to irritation 
or inflammation. 

Administration. — Podophyllum is used in the form of the extract 
(Extractum Podophylli, TL 8.), dose 1 to 5 grains, as the abstract 



286 DRUGS. 

(Abstractum Podophytti, U. $.), dose J- to 1 grain, the fluid extract 
(Extractum Podophytli Fluidum, U. S.), dose 2 to 20 drops, and more 
commonly than all, as the Pesina Podophylli, U. S. and B. P.), or 
Podophyllin, which is the best preparation. The dose of this prepa- 
ration is from -^V to y~o °f a grain as a laxative and from y 1 ^- to J a 
grain as a purge. The tincture of the resin (Tinctura Podophylli, 
B. P.) is given in the dose of 15 minims to 1 drachm. 



POMEGRANATE. 

Although Granatum ( V. S.) is official, it is almost never used in 
America in its crude form. It contains an alkaloid known as pelle- 
tierine, this alkaloid being a colorless liquid, soluble in 20 parts of 
water, and readily miscible with ether, chloroform, and alcohol. 
When acids are added to it, it forms crystalline salts, of which four 
are used, namely, the tannate, the sulphate, the hydrobromate, and the 
hydrochloride. The first is most commonly employed, and is a yel- 
lowish powder possessing an astringent taste. It is soluble in 700 
parts of water and 80 of alcohol. Its physiological action needs 
further investigation but it seems probable that the drug in poisonous 
amounts paralyzes the peripheral ends of the motor nerves in a 
manner closely resembling the action of curare. 

Therapeutics. — Originally pomegranate was largely used in the 
form of the rind of the fruit in decoction as a vegetable astringent, 
but this practice has ceased because of its disagreeable taste and effect 
upon the stomach. The ailments which were supposed to indicate its 
employment were serous diarrhoea and profuse sweats. In some 
tropical countries the bark of the root is used as a vermifuge and is 
very efficient in removing the tapeworm. It is said that the bark of 
the root of the wild shrub is much more efficacious than that of the 
cultivated and more handsome plant. To be efficacious the dose of 
the decoction of the bark must be large. The drug is prepared by 
soaking two ounces of the bark in two pints of water for twenty-four 
hours and then boiling down to a pint. A wineglassful of this is the 
dose which is generally given, and it may be repeated every hour 
until the whole amount is taken. The objection to this line of treat- 
ment is that it is unnecessarily severe, often purging and vomiting 
the patient excessively. The nausea produced is often great. Should 
purging fail to appear it is necessary to give castor oil or other purge 
to dislodge the worm and it is always necessary to starve the patient 
for twelve hours before the remedy is tried. 

The dose of pelletierine is 3 to 5 grains, and the tannate is the salt 
always employed. Practically the only pelletierine used is that of 
Tanret, and his preparation is a syrupy solution, in each bottle of 
which is one dose of the drug. 

As large doses as 20 grains of pelletierine have been used, but as 
very serious paralytic symptoms have ensued after the ingestion of 5 
grains by a susceptible woman, not more than this amount should be 



QUASSIA. 287 

given. When pelletierine is used it should always be followed in two 
hours by a purge. Those who have used it most place great reliance 
on it. 

The B. P. contains one official preparation of pomegranate, namely, 
the Decoctum G-ranati Radicis, the dose of which is 1 to 2 fluid- 
ounces. 

PRUNUS VIRGINIANA. 

Prunus Virginiana, Z7. 8., Wild Cherry as it is incorrectly called, 
is the bark of Prunus Serotina, a large tree of the United States and 
Canada. It contains two substances known as emulsin and amygdalin, 
which when they come together in water form hydrocyanic acid. 

Therapeutics. — Wild-cherry bark is largely used as a domestic 
tonic, and in the form of a syrup as a vehicle for cough mixtures. 

It has been supposed that the hydrocyanic acid present allays the 
cough, but this is doubtful, as the acid is very fleeting in its effect and 
present in very small quantity. 

Administration — As a tonic it is used in the form of the infusion 
(Infusum Pruni Virginiance, U. 8.), dose J to 1 ounce, and the fluid 
extract (Extr actum Pruni Virginiance Fluidum, U. 8.), dose 30 drops 
to 1 drachm. The syrup (Syrupus Pruni Virginiance, U. 8.) is given 
in the dose of 1 to 4 drachms. 



PYOKTANIN. 

This is really a methyl-violet, or aniline dye of any color, deprived 
of arsenic and any other impurities in order that it may not be irri- 
tating to wounds or mucous membranes to which it may be applied. 
Pyoktanin was introduced to professional notice under this name by 
Stilling as an antiseptic, but careful study has proved it to be of very 
feeble power over the growth of germs. In all conditions of the eye 
in which antiseptic lotions are indicated pyoktanin has been stated to 
be of value, but elsewhere in surgery it is practically useless. Even 
in the eye it possesses, according to De Schweinitz, a very limited 
range of usefulness, being no better than the older antiseptics except 
in diseases of the lachrymal apparatus. The fact that pyoktanin 
stains everything it touches is a great disadvantage in its use. It may 
be tried in blepharitis, eczema of the eyelids, conjunctivitis, both sim- 
ple and phlyctenular, and in the treatment of corneal ulcer. When 
employed it should be applied in the strength of 1 to 1000 of water. 



QUASSIA. 

Quassia, U. S., Quassias Lignum, B. P., is the wood of Picrama 
JExcelsa, a large tree of Jamaica and other islands of the West Indian 
group. It contains an active principle named quassin, which is 



288 DRUGS. 

intensely bitter and an irritant to mucous membranes. Quassia is a 
simple bitter tonic, which has been used very largely in domestic 
medicine and by the medical profession. It is very efficient, is sup- 
posed to be particularly useful in the anorexia following malarial 
fevers, and has even been thought to possess antiperiodic power. In 
simple dyspepsia with eructations after meals, not due to gastritis, it is 
very serviceable. 

In the treatment of seat-worms ( Oxyuris vermicularis) or thread- 
vjorms, as they are often called, injections of the infusion of quassia 
are the most efficacious and useful remedial measures we possess, and 
are also very harmless to the patient. The bowel should be well 
washed out by soap and water, and a half-pint to a pint of an infusion, 
made by adding 1 or 2 ounces of quassia chips to a pint of water, should 
be injected and retained for some minutes. A few such injections will 
invariably kill the parasites, provided the bowel is first well washed 
out with soap and water and enough fluid be injected to reach high up 
into the rectum. 

Administration. — The tincture (Tlnctura Quassias, U. 8. and B. P.) 
is given in the dose of J a drachm to 1 drachm, the fluid extract 
(Extr actum Quassias Fluidum, U. 8.) \ a drachm, and the extract 
(Extractum Quassias, U. 8. and B. P.) 1 to 3 grains. The infusion 
(infusum Quassice, B. P.) is given in the dose of J to 2 ounces, and is 
made by macerating 1 drachm of quassia with 10 ounces of water, and 
allowing it to stand twenty-four hours or more. 



QUEROUS ALBA AND TINOTORIA. 

Quercus Alba, U. 8., or White Oak, in infusion is used as an astrin- 
gent injection in gonorrhoea and vaginitis in the female, where a large 
amount of fluid is necessarily employed. It is also used as a wash 
in the treatment of prolapse of the rectum, for haemorrhoids, for leu- 
corrha&a and as a gargle in sore-throat. It stains the clothing very 
slightly. 

Quercus Tinctoria is equally efficient, but is seldom used because it 
stains the clothes very badly. Either may be used in infusion in the 
strength of 1 ounce to the pint of water. In the form of the pow- 
dered bark it is often used as an astringent poultice to freely running 
sores to check the discharge. Decoctum Quercus is official in the B. P. 



RESIN, or ROSIN. 

Resina, U. 8. and B. P., is Resin, or Rosin, the mass left after the 
distillation of turpentine, and enters largely into plasters, cerates, and 
similar preparations. Its burning fumes when inhaled are said to 
be of value in cases of chronic bronchitis. Ceratum Resinm, U. 8., is 
used in the treatment of chilblains and superficial scalds, and Em- 
plastrum Resinaz, U. 8. and B. P., is adhesive plaster. Unguentum 



RHUBARB. . 289 

Resinos is a B. P. preparation used for the same purposes as the 
plaster or cerate. 

RESORCIN. 

Resorcin is the meta compound of the group of which hydrochinone 
is the para and pyrocatechin the ortho, aud occurs in clear crystals of 
a slightly reddish hue. It is quite soluble iu water, alcohol, and ether. 

Physiological Action. — Resorcin is an irritant to mucous membranes, 
and when taken internally in poisonous doses causes deafness, giddi- 
ness, salivation, profuse sweat, unconsciousness, aud clonic convulsions. 
The heart of the dog under its innueuce is at first slowed by vagal 
stimulation, and then becomes very rapid from vagal palsy. 

Therapeutics. — Resorcin has been found of service as a remedy for 
whooping-cough, given in the dose of 10 drops of a 2 per cent, solution, 
or used in a spray of the same strength, the latter being the better 
method of using the drug. 

Resorcin has also been employed in a spray in 2 per cent, solution 
in hay-fever with remarkably good effects. It has been used as an 
antipyretic, but is not serviceable, and has little power over strong 
fevers. 

The chief use of resorcin is in skin affections of a subacute or chronic 
character, such as eczema, with much induration, and in psoriasis. In 
these states an ointmeut of the following character, well applied, is 
of service : 



M. 



After mixing the ointment, heat it until the resorcin crystals melt, 
to prevent any irritation of the skin. 



RHIGOLENE. 

This is a product of petroleum obtained by repeated redistillation 
until the liquid resulting from this process boils at 64.4° F. It 
evaporates more rapidly than any other known liquid, except cymo- 
gene, which boils at 32° F., and is used in a spray for the production 
of localized numbness or freezing before minor painful operations, 
such as the use of the actual cautery. 



RHUBARB. 

Rheum, U. S., Rheum Radix, B. P., is the root of Rheum Officinale, 
a plant of Thibet, but which is cultivated in America aud elsewhere. 
It is also derived from China, aud this variety is known as Chinese 

19 



J& . — Resorcin 


• 35- 


Zinci oxidi . . . . ... 


• 3J- 


Ung. aquse rosae ..... 


. 3X. 


Apply to the part affected twice a day. 





290 DRUGS. 

Rhubarb. Several alkaloids are contained in it, all of which are 
unimportant and never used alone, except chrysophanic acid. 

Physiological Action. — According to the studies of Prevost and 
Binet, rhubarb acts inconstantly upon the flow of bile, sometimes 
increasing it, sometimes having no effect, but, on the other hand, 
according to those of Rutherford and Vignal, it never fails to stimu- 
late biliary secretion. Owing to the astringent properties possessed 
by rhubarb it does not purge excessively, and improves the appetite, 
digestion and intestinal tone. 

Therapeutics. — Whenever it is desired simply to unload the bowels 
without affecting the general system, rhubarb may be employed. In 
other words, it is useful in simple constipation. In children a state 
is very commonly seen in which constipation is replaced by diarrhoea 
if any ordinary laxative is employed, and in these instances rhubarb 
is the best remedy, as it is astringent and prevents any after-effects 
beyond those produced by the dose. In the summer diarrhoea of 
children, where the stools are green, rhubarb is often used to empty 
the bowels of fermentative products before direct treatment is in- 
stituted. 

Administration. — The preparations of rhubarb are unnecessarily 
numerous. Rhubarb itself may be given in the dose of 20 grains in 
powder, and small pieces of the root are habitually chewed by some 
persons for the relief of constipation. Extr actum Rhei, TJ. S. and 
B. P., is given in the dose of 5 to 10 grains in pills. Pilulce Rhei, 
TJ. S., of which each pill contains 3 grains of rhubarb, is given in the 
dose of 1 to 3 pills ; and Pilulce Rhei Compositus, TJ. S. and B. P., 
which contain 2 grains of rhubarb and 1J of aloes, are given in the 
same dose. Pulvis Rhei Compositus, TJ. S. and B. P., contains 
magnesia, and is given in the dose of 20 to 40 grains; Ex- 
tractum Rhei Fluidum, TJ. S., is given in the dose of 20 to 30 minims. 
Syi^upus Rhei, TJ. S. and B. P., is given in the dose of 1 drachm to 
a babe, and 4 drachms to an adult, although rarely used for such 
persons. Syrup>us Rhei Aromaticus, TJ. S., is given in the same dose 
and to the same class of cases. Tinctura Rhei, TJ. S. and B. P., is 
used in the dose of 1 to 2 drachms, and Yinum Rhei, TJ. S. and B. P., 
in the dose of 1 to 4 drachms. Tinctura Rhei Aromatica, TJ. S., is 
used in the dose of J to 1 drachm, and Tinctura Rhei Bulcis, TJ. S., 
2 to 3 drachms. 

The aromatic syrup is commonly employed for children and the 
compound pills for adults. Infusum Rhei, B. P., is given in the 
dose of 1 to 2 ounces, and Mistura Rhei et Sodo3, TJ. S., in the dose 
of 2 drachms to 3 ounces. 



RHUS AROMATICA. 

Sweet Sumac is unofficial, but has been so largely used of late 
that it deserves notice. In hematuria, menorrhagia, diabetes, in- 
sipidus, and in urinary incontinence in children, depending upon 



EOSA GALLICA. 291 

vesical atony, it has been highly praised. In the latter affection a 
sufficient amount of experience has been acquired to show that it 
really is of benefit. Khus Aromatica should be used in the form of 
the fluid extract derived from the bark of the roots according to the 
general directions in the Pharmacopoeia for making fluid extracts. 
The dose as a remedy for urinary incontinence is 15 drops of this 
preparation. Adults may take 15 to 60 drops. The drug is best 
given with glycerin and water. 



RHUS GLABRA. 

Rhus Glabra, U. S., Smooth Sumac, is the fruit of Rhus Glabra, 
and contains tannic and malic acids as its chief constituents of medi- 
cinal value. In the fluid extract (Extractum Rhois Glabrae Fluidum, 
U. S.), we have an official preparation which is very efficient as a 
gargle for sore-throat when diluted with glycerin and water or prepared 
according to the formula given under Chlorate of Potassium. 



ROOHELLE SALT. 

Sodii et Potassii Tartras, U. S., Soda Tartar -ata, B. P., has been 
used as a saline cathartic in the dose of \ an ounce, and is preferred 
by many patients to Epsom salt, because its taste is not so disagreeable. 
It is, however, more irritating. Rochelle salt is the purgative con- 
stituent of Seidlitz powder. 



ROSA OENTIFOLIA. 

Rosa Centifolia, U. S, Rosce Centifolice Petala, B. P., Pale Kose, 
possesses almost no medicinal value, but is mentioned because its 
official preparations are largely used in practice. 

Aqua Rosce, U. 8. and B. P., is used a diluent or solvent for 
preparations, such as astringents, which are to be employed locally, as 
in injections for gonorrhoea. It may also be used internally for these 
purposes. Unguentum Aquce Rosce, U. 8., is " cold cream," and is 
largely used as an emollient application to small burns, sores, cuts, 
scratches, and chapped hands and lips. It is much improved if a 
little glycerin and benzoic acid are added to keep it sweet in warm 
weather. 

ROSA GALLIOA. 

Rosa Gallica, U. 8., Rosce Galliccc Petala, B. P., Eed Eose, con- 
tains more gallic and tannic acids than pale rose, and is astringent. 
From it are prepared the Extractum Rosce Fluidum, U. S., dose 5 
drops to 2 drachms, used to flavor other extracts, and the Confectio 



292 DRUGS. 

Bosce, U. S. and B. P., which is used as a basis for pills. Mel Bosoz, 
TJ. 8., or honey of rose, is employed as a local application or as a 
vehicle for gargles, and the Syrapus Bosce, XI. 8. and B. P., dose 1 to 
2 drachms, as a flavoring substance. The acid infusion (Infusion 
Bosce Acidum, B. B.) is given in the dose of 1 to 2 ounces. 



RUBUS IDiEUS, or RASPBERRY. 

Bubus Idceus, U. S., or Raspberry, is used for the preparation of 
a syrup (Syrupus Bubi Idcei, II. S.) which is employed very largely 
as an elegant vehicle or flavoring mixture. The leaves are often 
used in domestic medicine in a decoction or infusion for the cure of 
diarrhoea when an astringent is neeeded. 



RUE. 

Buta Graveolens is the source from which we derive the Oil of Rue 
(Oleum Buta, U. S. and B. P.). 

Physiological Action. — Locally applied, rue is au irritant, produc- 
ing vesication, and if taken internally in large amount gastro -enteritis, 
which may be most severe. It is eliminated by the lungs, kidneys, 
and skin, and its odor is easily noticed in all these secretions. If the 
dose be poisonous, vomiting, great pain in the belly, and epileptiform 
convulsions come on, but death has rarely occurred. 

Therapeutics. — Rue has been used as an abortifacient, but with 
great danger to the mother. Its action is most uncertain even when 
poisonous doses are employed. It has been given in colic as a car- 
minative, and seems to be really valuable in atonic menorrhagia and 
metrorrhagia. 

Given in capsule, oil of rue has been employed for the removal 
of lumbricoid or round-worms, but ought not to be so used. The 
dose of the oil is 3 to 6 drops. 



SACCHARIN. 

Saccharin is a compound first prepared by Fahlberg under the 
direction of Professor Remsen, of Johns Hopkins University. It is 
a remarkably sweet substance, 220 times stronger than sugar in 
sweetening power, and is used largely to sweeten glucose and in 
confections. It escapes from the body unchanged, and has been 
used in the treatment of cases of diabetes and gout to sweeten coffee, 
food or medicine. 

The dose is indefinite, but it is to be noted that a very few grains will 
sweeten a very large bulk of material. 

Physiological Action. — Upon the circulation and similar vital 
functions saccharin has no effect, but Pliigge has proved it to retard 



SALICYLIC ACID. 293 

the action of all the digestive ferments and to be in consequence 
harmful to diabetics whose digestion is impaired. 



SALICYLATE OP BISMUTH. 

Salicylate of Bismuth is a white, soft powder, insoluble in water, 
alcohol, ether, aud chloroform, but soluble in acids. It is largely used 
by some practitioners, particularly on the European continent, as an 
intestinal antiseptic in cases where, in the presence of gastro-intestinal 
catarrh, fermentation or putrefaction is thought to be present in the 
bowel. It is to be given in powder, or better still, in capsules, in the 
dose of 3 to 15 grains. 



SALICYLATE OP MERCURY. 

Salicylate of Mercury is a drug which has come into quite general 
use since the introduction of the hypodermic method of administer- 
ing mercury in syphilis. It is to be suspended in paraffin oil in the 
proportion of 22 grains of the salicylate of mercury to 3 drachms of 
the oil, and before it is used the bottle must be well shaken in order 
that the insoluble mercury may not remain at the bottom. It is of 
great importance that the needle and syringe shall be thoroughly 
cleansed after each injection, as the insoluble drug readily clogs the 
opening of the instrument. At first one minim of the mixture just 
named should be injected deeply into the gluteal region every fourth 
day, and this may be increased to every second day if no systemic 
evidences of the action of the drug appear. 



SALICYLIC ACID. 

Salicylic Acid (Acidum Salicylicum, TJ. S. and B. P.) is derived 
from carbolic acid by treating it with caustic soda and carbonic acid 
at a moderate heat. It is soluble in 300 parts of water and 4 parts 
of alcohol. 

Physiological Action. — On mucous membranes salicylic acid acts as 
an irritant. (See Poisoning.) 

Nervous System. — Upon the nervous system salicylic acid exerts 
comparatively slight effects in medicinal doses, causing buzzing in the 
ears, decrease of the reflexes, and finally producing, in overdose, 
epileptiform convulsions by an action on the brain. 

Circulation. — Upon the circulation the effects of salicylic acid 
are not very marked in medicinal dose. It undoubtedly has a 
depressant rather than a stimulant effect, but the depression is very 
slight. It is sufficient, however, to make the use of the drug in cases 
of feeble circulation worthy of thought and care. 



294 DRUGS. 

Respiration. — Salicylic acid stimulates the pulmonary vagi and 
respiratory centre, but if the dose be poisonous death is due to 
respiratory failure. 

Temperature. — The effect of salicylic acid on temperature has 
been studied by the author with a good deal of care. The drug 
acts as a distinct antipyretic upon fevered states, and is a slight 
depressant of normal bodily heat. The studies of Gedl, Fiir- 
bringer and See also show this, and those of Danewsky point to it. 
In the experiments of North upon man, after and during exercise, 
the antipyretic effects were marked. According to the author's 
studies, the drug lowers fever by diminishing heat-production and 
increasing heat-dissipation, but this is by no means positively de- 
cided as a fact. 

Absorption and Elimination. — Salicylic acid is absorbed from 
the stomach as a salicylate of sodium and so circulates in the blood. 
It is eliminated by the kidneys, and by all the secretions. In the 
urine it appears as salicyluric acid. The urine after large doses is 
dark olive-green, and the change in color is due to the presence of 
indican and pyrocatechin, which are formed by the action of the 
pancreatic juices upon the drug in the intestine. The presence of 
salicylic acid in the urine is to be discovered by the addition of a 
solution of the chloride of iron to that fluid, which causes the appear- 
ance of a violet color. 

Poisoning. — Salicylic acid when taken in excessive dose causes 
profuse sweating, roaring in the ears, dimness of vision, headache, 
partial or total deafness, and a decided fall in temperature. The 
pulse becomes weak and relaxed, and finally ptosis, strabismus, and 
general paralysis ensue. The urine and faeces are passed involun- 
tarily, and the urine is olive-green in color. The respirations at first 
are quickened and deepened, but finally become shallow and feeble, 
death ensuing from respiratory failure. 

If the dose is sufficiently large the blood is involved and the cor- 
puscles rapidly break down. 

Therapeutics. — Salicylic acid, owing to its close resemblance to 
quinine, was first introduced as an antiperiodic and antipyretic, but 
soon was found to be of an inferior value in these states and of super- 
lative value in rheumatism. At present, it is rarely if ever used for 
either of the former purposes, but is largely employed as a standard 
remedy for the latter trouble. 

The value of salicylic acid in rheumatism limits itself solely to 
the relief of pain and the cure of the malady without preventing the 
complications incident to its course. That is to say, the changes in 
the joints or heart in rheumatism are only of less frequency after the 
use of salicylic acid, because the drug shortens the disease, and not 
because it prevents these changes by a direct influence ; this is also 
seen in rheumatic hyperpyrexia, where salicylic acid is of service, 
though it often fails to control the temperature to any great extent. 
In acute rheumatism 10 to 15 grains should be given hourly or every 
two hours, until marked physiological symptoms occur. It is to be 



SALICYLIC ACID. 295 

remembered, however, that in many cases the salicylates are of no 
value whatever, merely producing sweats and headaches, and it is also 
worthy of note that nothing else does these cases much good, as they 
seem bound to run a given course before the patient recovers. If a 
cure does take place relapses are very common indeed, and the drug 
should always be continued for several days after all symptoms cease. 
In gonorrhoea! rheumatism the salicylic acid is of little value until the 
gonorrhoea is cured,' when the rheumatism also ceases whether we 
give salicylates or not. In rheumatoid arthritis it is entirely value- 
less, and the same statement is true in regard to gout. In chronic 
rheumatism citrate of potassium and sodium may be used in place of 
the salicylic acid, in the dose of 30 to 60 grains, and these salts are 
to be taken just before going to bed. In lumbago, sciatica, and similar 
states, salicylic acid is a very useful remedy. While it is not as good 
as antipyrine in neuralgia, it is of great service in the migraine of 
rheumatic persons, often entirely curing the disease. Haig has proved 
that the salicylic compounds all aid in the excretion of uric acid, and 
thinks they relieve rheumatism in this manner. 

In quinsy or true tonsillitis the drug is a specific, particularly when 
rheumatism is the cause. It will generally prevent suppuration, 
shorten the attack, and relieve the pain and swelling. The doses 
should be small, and given hourly, say 3 grains at each dose. In 
stomatitis, after the blisters have broken, the burning and pain are 
often intense, and a mouth-wash of salicylic acid in the proportion of 
1 to 250 of water is useful. 

Ringer recommends the use of the following salve in pruritus of 
the anus and vulva : 

R. — Acid, salicylic gij. 

01. theobromse 3 v. 

Cetacese ^iij. 

01. myristicse f^iss. M. 

In the treatment of corns there is probably no better application 
than lint soaked in a solutiou of salicylic acid, or the use of the 
following formula : 

R. — Acid, salicylic. gr. xxx. 

Ext. cannab. indicse . . . < gr v. 

Collodii fgss. M. 

S. — Apply with a brush until a good coat is formed. 

A solution of salicylate of sodium or of bicarbonate of sodium, 
applied on lint to inflamed rheumatic joints, often gives great relief. 

In gastric dilatation or catarrh, where vomiting occurs, and the 
matters vomited contain sarcinai, salicylic acid will be found of ser- 
vice, and Bartholow thinks it of value in paroxysmal gastralgia. In 
adults suffering from ascaris lumbricoides, or round-ioorms, salicylic 
acid may be used in the dose of 8 grains every hour till 40 grains 
are taken. For thread- or seat-worms the following injection will be 
found of service : 



296 DRUGS. 

R. — Acid, salicylic £ss. 

Sodii borat 5 ss. 

Aquae Oj. M. 

S.— Warm, and inject into the bowels. For a child reduce this one-half in all 
its parts. 

In bromidrosis of the feet (excessive sweating with foetor) salicylic 
acid may be dusted over the parts, or the following powder used : 

R. — Acidi salicylic. ") „ , T 

Pulv.amyl. } aa |ss. M. 

S. — Apply to the feet. 

In eczema of the face and hands, where the eczema is of the wet or 
weeping variety, salicylic acid, locally applied, is often of great service. 

Antiseptic Use. — Salicylic acid is employed as an antiseptic in the 
treatment of wounds, as a local remedy and as a dressing, but should 
not be applied over too large an area, as it may be absorbed, and pro- 
duce constitutional symptoms. As an application to small burns, a 
mixture of 1 drachm of salicylic acid to 8 ounces of olive oil is of 
service. 

In the treatment of soft chancres and venereal sores salicylic acid 
has been largely used by some practitioners either as a salve or as a 
dusting-powder, as follows : 



Or 



ft. — Acid, salicylic. 
Alcohol. 
Adipis benzoinat. 



gr. xx. 
gtt. xlv. 
Sij- 


M. 


gr. xv. 
3ij- 


M. 



ft. — Acid, salicylic. . * 

Pulv. amyli vel cretae .... 

Salicylic acid may be added to urine to keep it sweet, but will some- 
times cause the tests for sugar to appear. Patients taking salicylic 
acid often notice that the urine is odorless after standing, and that it 
will remain fresh for many days. 

Untoward Effects. — Salicylic acid, as already stated, may produce 
headache and roaring sounds in the ears. In persons with middle-ear 
disease it is contra-indicated unless urgently called for, as it often 
makes the deafness permanently worse. Sometimes erythema or acne 
follows its employment, and blindness and retinal haemorrhages have 
been found to occur. It would be impossible to enumerate all the 
untoward effects which have been noted, but it is w r orthy of remark 
that very few deaths have taken place. 1 

Administration. — Salicylic acid has a nauseous, disagreeable taste 
and is irritant to the stomach. It should be given in a solution of 
glycerin and water, or its taste may be covered by the use of syrup 
of bitter orange peel or syrup of ginger. The following formulae 
may be used : 



M. 





Bc . — Acid, salicylic. 

Tinct. lavandulae comp. 
Glycerini .... 
Aquae ..... 


• 3ij- 

. f^iv. 
. ." . f|ss ;i 
q. s. ad f^viij. 


s.- 


—A tablespoonful every two hours. 





See author's essay on Antipyretics. 



SALOL. 297 

R. — Acid, salicylic ^ ij. 

Glycerini fjfss. 

Syrup, aurantii f %iy. 

Aquae . . . . . . q. s. ad f^viij. M. 

S. — A tablespoonful every two hours. 

Salicylic acid may be used in pill or capsule, but is irritant to the 
stomach in so concentrated a form ; it must be taken with much water, 
and should follow rather than precede meals. Salicylic acid ointment 
( Unguentum Acidi Salicylici, B. P.) is a useful preparation for external 
application in chronic deep-seated skin diseases. 

If buzzing in the ears is annoying, bromide of sodium in the dose 
of 20 grains will generally give relief. 

Salicylate of Sodium. 

Salicylate of Sodium (Sodii Salicylas, U. S. and B. P.) is a less 
irritant and somewhat less disagreeable preparation than salicylic acid. 
Its action, use, and doses are the same as the acid. 

Other salicylates are largely used by some persons. Salicylate of 
Lithium is supposed by some physicians to be of more value than the 
other salts. 

SALOL. 

In appearance, Salol is a white crystalline powder, faintly aromatic 
and almost without taste. It is not soluble in water, but is so in alco- 
hol, and an alcoholic solution forms an imperfect emulsion when mixed 
with water. Salol is also slightly soluble in copaiba, in the oils of 
sandalwood and of turpentine, and in mineral oils. This solubility is 
very useful in prescribing it with these remedies in certain diseases of 
the genito-urinary apparatus. (See Gonorrhoea.) 

Salol is a compound of 60 parts of salicylic acid and 40 of carbolic 
acid, and is decomposed by the pancreatic juice into these two sub- 
stances. For this reason overdoses will produce symptoms of carbolic 
acid poisoning. Thus twenty grains taken five times a day will cause 
a man to take 40 grains of carbolic acid, which is almost a poisonous 
dose. 

Hesselbach has proved that salol is very apt to affect the kidneys 
unfavorably, and rightly believes it to be contra-indicated in all cases 
of renal inflammation of an acute type. 

It is worthy of note that the drug rarely produces untoward effects, 
although at one time a number of observers accused it of doing so 
frequently. 

Salol is used for the same purposes as salicylic acid, when the stom- 
ach is irritated and cannot bear the latter drug, as it is dissolved in 
the small intestine. A dose often used is 10 grains an hour, but this 
is too much, as a rule, aud may produce dangerous symptoms. Salol 



298 DRUGS. 

may be given in wafers, capsules, or pills. It is of the greatest value 
in duodenal catarrh and catarrhal jaundice. 

In the treatment of gonorrhoea, in all its stages, salol may be em- 
ployed by the mouth, as it sterilizes the urine and tends to disinfect 
or sterilize the urethra at each act of micturition. (See Gonorrhoea.) 

Salol is of very great value in functional disorder of the intestines. 
Indeed, there is no other remedy which can exert the same power for 
good in cases of intestinal indigestion and fermentation. In diarrhoea, 
dependent upon such causes, salol is one of the best remedies we have, 
since it renders the canal antiseptic and so removes the cause of the 
disorder instead of locking the putrid material in the bowel as does 
opium. In the writer's practice salol has come to be one of the most 
valued drugs in the treatment of the affections just named, and also 
in muscular rheumatism and neuralgia, due to exposure. In cholera 
morbus the writer's friend, Dr. Fussell, of Philadelphia, has found the 
following very useful : 

R.— Salol 3j. 

Bismuth, subnitrat. gij. 

Misturse cretae . . . . q. s. ad f 3 iij. M. 

S. — Two teaspoonfuls every two hours. 



SALOPHEN. 

Salophen has been introduced into medicine within the last few 
months as a substitute for salol, and it is said to possess the advantage 
of being far less poisonous than salol, because in this case the phenol 
of the salol is replaced by a compound of phenol which is innocuous. 
Experiments on animals seem to indicate that these theoretical advan- 
tages are present in fact. Like salol, salophen is broken up in the in- 
testine by the juices there present, and the result is salicylic acid and 
acetylparamidophenol. Salophen contains about 10 per cent, more 
salicylic acid than does salol (51 per cent.) and appears in the form of 
thin, white laminae, nearly insoluble in water. It is tasteless. 

Therapeutics. — For the therapeutics of salophen the reader is re- 
ferred to the article on Salol, as the indications for both drugs are 
identical save that salophen can probably be used when salol cannot be 
employed. The dose of salophen is from 5 to 20 grains three times 
a day. It can be very effectually combined with phenacetine in the 
treatment of neuralgia. 



SANDALWOOD. 

Sandalwood (Santalum Rubrum, U. 8.), or Red Saunders, is the 
wood of the Pterocarpus Santalinus, a tree of India and the Sandwich 
and Feejee Islands. It is known under the name of Pterocarpi 
Lignum in the B. P. From it is derived an oil ( Oleum Santali, U. S. 
and B. P.) which has a hot, burning taste. The odor is very pleasant 



SANTONIN. 299 

and it has been used as a perfume. In overdose the oil is capable of 
producing great irritation of the genito-urinary passages. 

Therapeutics. — The oil of sandalwood, often called erroneously the 
"oil of yellow sandalwood," is much used by genito-urinary surgeons 
in chronic gonorrhoea and gleet for the purpose of stimulating depraved 
mucous membranes to proper action, and in chronic cystitis to act as a 
tonic to the bladder. 

In the subacute or later stages of bronchitis, when the expectoration 
is thick and ropy and the cold is not readily " thrown off/ 7 the oil of 
sandalwood is efficacious. In all cases it should be given in capsules 
in the dose of 5 to 20 drops, 5 drops being generally sufficient. Oil 
of sandalwood may irritate the stomach, but it is not so apt to do so 
as are cubebs or copaiba. 



SANGUINARIA. 

Sanguinaria, U. S., or Blood Root, is the rhizome of Sa?iguinaria 
Canadensis, and has been largely used in medicine, but is a dangerous 
remedy, possessing more power for harm than good. Its chief alkaloid 
is sanguinarine. 

Poisoning. — Sanguinarine in poisonous dose causes vomiting, purg- 
ing, profuse salivation, and finally tonic convulsions which are spinal 
in origin. Death is due to respiratory failure, but the circulation is 
much decreased in force and frequency. 

Therapeutics. — The employment of sanguinaria in chronic bronchitis 
is about the only purpose for which it is now employed to any extent. 
As an emetic in croup it has been largely used, but is too irritant and 
depressant and ought not to be so employed. According to Bartholow, 
the drug acts as an hepatic stimulant and is of service in g astro-intestinal 
catarrh with jaundice. 

Administration. — The dose of the fluid extract (Extractum San- 
guinaria; Fluidum, IT. S.) is 1 to 5 drops as an expectorant, or 10 to 30 
drops as an emetic. If the drug does not cause vomiting after an 
emetic dose it must not be allowed to remain in the stomach. The 
tincture (Tinctura Sanguinarice, IT. S.) is the best preparation to use, 
and may be given in 20 to 30-drop doses as an expectorant, and 1 to 3 
drachms as an emetic. The vinegar (Acetum Sanguinarim, IT. S.) is 
given in the dose of 10 to 30 drops, and as an emetic in the dose of 
2 to 4 drachms. 

SANTONIN. 

Santoninum, IT. S. and JB. P., is a neutral principle derived from 
Levant Worm-seed or Santonica, which is the un expanded flower- 
heads of Artemisia Maritima, a plant of Asia Minor and Turkestan. 
Santonin is soluble in alcohol and chloroform, but less so in water. 
Santoninic acid is formed by warming santonin with alkalies, and 



300 DRUGS. 

Hesse has found that santonin is an anhydride of santoninic acid. 
Santoninic acid is more soluble than santonin. 

Poisoning. — Santonin causes muscular tremors, convulsive move- 
ments, unconsciousness, and sometimes epileptiform convulsions. 

One of the most common symptoms of the poisoning is chromat- 
opsia or xanthopsia, during the existence of which all objects look 
yellow. This is due to the staining of the humors of the eye by the 
drug. This may go on to total blindness, or pass away in a few days. 
If the color is not yellow, it may be green. The urine is also 
stained — first yellow, then saffron, and finally purple-red, or is 
bloody-looking. This is not due to the presence of blood, but to 
the drug. Poisonous doses of the drug do not cause gastro-enteritis. 

Therapeutics. — Santonin is used for the removal of round-worm, 
and is very efficacious. It has no influence on the tape- worm. It 
should be given in the manner of all vermifuges (see Worms), 
namely, at a time when the alimentary canal is empty. Santonin 
is said to have a distinct influence over vision, increasing, in 
medicinal amount, its acuity whenever the optic nerve is at fault. 
In urinary incontinence santonin will often produce cure after all 
other remedies fail. 

Santoninate of Sodium (Sodii Santoninas, U. S.) is a useless, harm- 
ful preparation, never to be employed except for the benefit of the 
eye when vision fails through disease of the optic nerve. Introduced 
into medicine because of its solubility, it is absorbed into the system, 
which is just what is least desired in an anthelmintic, which should 
seek the worm in the bowel, not by entering the blood. In eye affec- 
tions the dose may be from 2 to 8 grains, according to the age of the 
adult. 

Santonin may also be given in the dose of 1 to 2 grains to an adult 
in capsules or wafers. The crystals should be used, not the powdered 
santonin. If the bowels are not opened within ten hours after the 
drug is used, a saline purge should be given, preceded preferably by a 
2 or 3-grain dose of calomel, taken half an hour before, as the flow 
of bile caused by the mercurial is particularly useful in making the 
worm let go its hold. 

Administration. — Santonin is best given in the form of a troche 
or lozenge (Trochisci Santonini B. P.), but it is to be distinctly borne 
in mind, and written on the prescription, that the Trochisci Sodii San- 
toninatis, U. S., are not to be sold to the patient. The troches of 
santonin itself are not official in the U. S. P., and it is better for the 
physician to write for troches to be made as follows : 

R . — Santonini gr. v. 

Pulv. sacchari alb. giij. 

Pulv. acacise gr. viij. 

Misce bene, et adde 

Acacise mucilag gtt. xvj . 

Aquae q. s. 

Ft. in troches no. x. S. — One or two lozenges, as directed. 



SAVINE. 301 



SARSAPARILLA. 



Sarsaparilla, U. S., is the root of Smilax Officinalis, Smilax Medico, , 
and other species of smilax growing chiefly in Central America. It is 
known in the B. P. as Sarsce Radix. The drug is largely devoid of 
any physiological action, yet seems to possess some power over the 
general condition of the system. Thus while sarsaparilla seems 
utterly without effect in the hands of most physicians when given 
alone, it often seems to do good and to increase the effects of other 
drugs when combined with them, so that some cases of syphilis which 
are of an obstinate character, will yield to iodide of potassium and 
sarsaparilla when the iodide alone fails. Sarsaparilla is largely used 
in domestic medicine as a " blood purifier," and is a prominent con- 
stituent of many patent medicines. 

Administration. — Sarsaparilla is most commonly given in the form 
of the compound syrup (Syrupus Sarsaparilla? Compositum, U. S.), 
composed of sarsaparilla, sassafras, guaiacum wood, liquorice, pale 
rose, gaultheria, anise, and senna, dose 1 to 4 fluidrachms. The other 
official preparations of the U. S. P. are the compound decoction (De- 
coctum Sarsaparillce Compositum), composed of the same principal 
ingredients as the compound syrup, except that anise, senna, pale rose, 
and mezereum are omitted, dose 4 to 6 fluidrachms ; the compound 
fluid extract (Extraetum Sarsaparillce Compositum Fluidum), similar 
to the syrup in composition, dose J- to 1 fluid rachm; and the fluid 
extract [Extraetum Sarsaparillce Fluidum), dose J- to 1 fluidrachm. 
The B. P. preparations are a decoction (Decoctum Sarsce), dose 2 to 
10 fluidounces; a compound decoction (Decoctum Sarsce Compositum), 
which is identical with the decoction of the U. S. P. ; and a liquid 
extract (Extraetum Sarsce Liquidum), dose J to 4 fluidrachms. 



SAVINE. 

Sabina, U. S., Savince Caeumina, B. P., is the tops of the Juniperus 
Sabina, an evergreen shrub of northern Europe, Asia, and America. 
It contains an official volatile oil (Oleum Sabince, U. S. and B. P.). 
Locally applied, it is more of a counter-irritant than is turpentine, and 
if swallowed in poisonous amount causes nausea, vomiting, gastro- 
enteritis, unconsciousness, suppression of urine, and death. If the 
individual be a pregnant female abortion takes place as death ap- 
proaches, but very rarely before this time. Profuse flooding nearly 
always accompanies the act. 

Therapeutics. — The oil, taken in the dose of 5 to 10 drops, repeated 
every three or four hours, acts as a powerful stimulant to the uterus 
and ovaries, causing hyperemia and aiding in the production of men- 
struation in cases of amenorrhea. It may also be employed to give 
tone to the uterus in menorrhagia. The drug is best given in emulsion 
or capsule. The fluid extract (Extraetum Sabince Fluidum, V. S.) is 



302 DRUGS. 

given in the dose of 5 to 15 minims; the tincture (Tinctura Sabince, 
B. P.), in the dose of 20 minims to 1 drachm. The ointment (Un- 
guentum Sabince, B. P.) is used as an external application to irritate 
the skin. 

SOAMMONY. 

Scammonium, U. 8. and B. P., is a resinous exudate from the root 
of Convolvulus Scammonia, growing in Asia Minor and Syria. Its 
active principle is sometimes called jalapin. 

Therapeutics. — Scammony is an irritant, drastic, hydragogue purge, 
which causes a good deal of griping, and exerts a cholagogue effect. 
If any inflammatory action of the bowels is present its use is contra- 
indicated. 

The ingestion of poisonous doses is to be followed by treatment 
suitable to gastro-enteritis. Scammony is given in the dose of 2 to 5 
grains, always in combination with some other similar drug, as, for 
example, colocynth. Scammony forms part of the compound extract 
of colocynth (JExtr actum Colocynthidis Compositum, U. S), the dose of 
which is 1 to 3 grains as a laxative or 5 to 20 grains as a purge. The 
resin (Besina Scammonii, U. 8. and B. P.) is given in the dose of 3 
to 8 grains. The B. P. preparations of scammony are Mistura Scam- 
monii, dose J to 2 ounces ; Confcctio Scammonii, dose 10 to 30 grains ; 
JPilula Scammonii Composita, dose 5 grains ; and Pulvis Scammonii 
Compositus, dose 10 to 20 grains. The last two preparations are com- 
posed of scammony, ginger, and jalap. 



SOOPARIUS AND SPARTEINE. 

Scoparius, U. 8., Scopari Cacumina, B. P., or Broom, is the tops 
of the Sarothamnus Scoparius. It contains scoparin and sparteine, 
the first being a crystalline principle and the second a liquid alkaloid. 
The second (sparteine) is the alkaloid used in medicine in the form of 
a sulphate, which is a crystalline salt readily soluble in water. 

Physiological Action. — As scoparius depeuds for its medicinal value 
almost entirely upon sparteine, what is here said applies to both the 
crude drug and the alkaloid. 

Nervous System. — Sparteine acts on the nervous system very 
decidedly if given in large dose, depressing the brain and spinal cord, 
chiefly in its motor tracts, thereby causing a decrease of reflex action 
and motor power, ending in complete paralysis. These changes occur 
both in man and in the lower animals. The heart is said to be stopped 
in systole. 

Circulation. — Upon the circulation sparteine acts as a stimulant. 
It quickens the pulse-rate in moderate doses, and also raises arterial 
pressure. The force of the contraction of the ventricles is also in- 
creased. In very large poisonous doses the drug acts as a circulatory 
depressant. 



SEIDL1TZ POWDER. 303 

Respiration. — Upon this function in small amounts sparteine has 
no effect, but poisonous doses kill by paralysis of the respiratory centre. 

Poisoning*. —The symptoms of poisoning consist in trembling and 
incoordination of movement, and clonic and tonic convulsions, followed 
by a second stage of depression of the nervous system and general en- 
feeblement. 

Therapeutics. — Sparteine has been recommended in all states of the 
heart in which digitalis is of service, and it is sometimes useful in those 
fairly frequent cases where digitalis fails. In cardiac arhythmia or pal- 
pitation, it is thought to be of great service by those who have used it 
most. Clark found it of value in Graves's disease and in nearly every 
circulatory abnormality, but in the judgment of the author of this 
book sparteine is generally a useless drug, only to be turned to as a 
last resource after more generally known remedies fail, or in other 
words, it is not a remedy to be used as a " stand-by " in the manner in 
which digitalis is employed. 

While some clinicians have found sparteine of value, many of them 
have not. In the few cases in which it has been used by the writer it 
entirely failed to be of service. The dose is as variable as its action. 
Some state it to be -fa of a grain, while still others recommend 2 to 4 
grains. A small dose should be used at first, and rapidly increased 
until some effects ensue. The drug should be given in watery solution. 

Scoparius itself is used in decoction, made by adding half an ounce 
of the broom tops to a pint of water, and boiling them down to a half- 
pint. Of this, an ounce should be taken every three hours. This 
decoction is one of the most efficient diuretics in cardiac dropsy. An 
unofficial fluid extract is given in the dose of 30 drops. The official 
preparations of the B. P. are a decoction (Decoctum Scoparii), dose 1 
to 3 ounces, and the juice (Succus Scoparii), dose 1 to 2 drachms, 



SEIDLITZ POWDER. 

Under the official name of Pulvis Effervescens Compositus, the U. 8. P. 
recognizes a purgative powder made by taking the bitartrate of sodium 
and potassium, or Rochelle salt, 120 grains, and bicarbonate of sodium 
40 grains, which are wrapped in blue paper, and 35 grains of tartaric 
acid placed in a white paper. The contents of each paper are dissolved 
in a little water — half a tumblerful — and the two solutions added to 
one another and swallowed during effervescence. As much as two 
powders may be used, but this is generally too large an amount unless 
full purgation is needed. In sick stomach associated with constipation 
when a whole powder cannot be retained, the two powders should be 
divided in fourths and a fourth added to a fourth in a half-wineglass- 
ful of water and taken every 15 minutes until the entire powder is 
ingested. This will often settle the stomach and produce purgation. 



304 DRUGS 



SENEGA. 



Senega, U. S., Senegce Radix, B. P., is the root of Poly gala Senega, 
a small plant of the United States, containing a principle known as 
polygalic acid and senegin. 

Therapeutics. — Senega is used in medicine as a stimulating expec- 
torant in the subacute and chronic forms of bronchitis. It has also 
been employed as a diuretic in cardiac dropsy or that due to renal dis- 
ease. In cardiac disease it should not be used, and indeed it is rarely 
employed at present except in combination with other drugs in expec- 
torant mixtures. 

Administration. — Senega is used in the form of an abstract (Ab- 
stractum Senega?, U.„ S.), dose 5 to 10 grains, the fluid extract 
\Extr actum Senegce Fluidum, U. S.), dose 10 to 20 drops, and the 
syrup {Syrupus Senegce, U. S.), dose 1 to 2 drachms. It is also used 
in Coxe's Hive Syrup. The official preparations of the B. P. are 
a tincture ( Tinctura Senegce), dose 1 to 2 drachms, and an infusion 
(Infusum Senegce), dose 1 to 2 ounces. 



SENNA. 

Senna, U. S., is the most drastic of the laxative purges used for the 
relief of constipation. It is the leaflets of Cassia Acutifolia and Cassia 
Elongata and contains a very acrid irritant purgative principle known 
as cathartic acid. Senna is official in the B. P. as Senna Indica and 
Alexandrina. 

Physiological Action. — Senna acts as a purge, producing copious 
stools, often with a great deal of griping if it is used alone. Accord- 
ing to Eutherford and Yignal, it acts very materially in increasing 
the flow of bile, but it is seldom, if ever, used in medicine as a chola- 
gogue, although, according to Prevost and Binet, cathartic acid has an 
influence over biliary secretion. Hess has found that the drug acts 
directly as a stimulant upon the mucous membranes and so produces 
a local peristalsis as it is moved along. It is also known that the 
drug acts as a purge when absorbed from the skin, and for this reason 
nursing mothers should not take senna, as it will purge the nursling. 

Administration. — Senna is generally combined Avith other drugs for 
the relief of constipation, but may be used alone. If this is done the 
fluid extract {Extractum Sennce Fluidum, U. S.) may be employed in 
the dose of 1 to 2 drachms to a child or 4 drachms to an adult. It 
is, however, always better to give children the more agreeable confec- 
tion (Confectio Sennas, U. S. and B. P.) in the dose of J drachm to a 
child, or 1 to 2 drachms to an adult. As the confection is apt to 
cause gastric disorder if used continuously, because of the sugar con- 
tained in it, its use is limited to a certain class of cases. 

In the treatment of the constipation of pregnancy senna is thought 
to be very useful. Under the name of Black Draught a mixture of 



SILICATE OF POTASSIUM OR SODIUM. 305 

senna, manna, and sulphate of magnesium has been largely used 
(Infusum Sennce Compositum, TJ. 8.), in the dose of 4 ounces. It is 
an active hjdragogue purge. The syrup (Syrupus Sennce, TJ. 8. and 
B. P.) is given in the dose of 1 to 4 drachms. 

One of the best ways to use senna is iu the compound liquorice 
powder (Pulvis Glycyrrhizce Oompositus, TJ. 8. and B. P.), which is 
a good laxative in the dose of 20 to 30 grains. Compound liquorice 
powder is composed of senna, liquorice, fennel, washed sulphur, and 
sugar. 

Infusum Sennce, B. P., is given in the dose of 1 to 2 ounces ; Mis- 
tura Sennce Composita, B. P., in the dose of 1 to 2 ounces, and 
Tinctura Sennce, B. P., in the dose of 1 to 4 drachms. 

Senna may stain the urine red, and no alarm should be felt if this 
color appears in this secretion. Often it is necessary to warn the 
parents of a child of the possibility of such an occurrence, in order to 
prevent any fright on the part of the mother, who otherwise might 
think that hematuria was present. 



SERPENTARIA. 

Serpentaria, TJ. S., Serpentaria Rhizoma, B. P., or Virginia Snake- 
root, is the rhizome and rootlets of Aristolochia Serpentaria and Aris- 
tolochia Reticulata, plants of the southern United States. It contains 
an active principle, aristolochin, which is never used in medicine. 

Therapeutics. — Owing to the rather pleasant, warm taste of ser- 
pentaria, and the fact that it stimulates secretion, it is used largely as 
a vehicle for other more potent remedies. It has tonic properties, and 
in consequence has been largely used in the treatment of atonic dys- 
pepsia and indigestion. It is even said to be a sexual stimulant, but 
this is doubtful, to say the least. In overdose it is an irritant and 
will cause vomiting and purging if large amounts are taken. 

Administration. — Serpentaria is given in the form of the extract 
(Extractum Serpentaria Fluidum, TJ. 8.) in the dose of 10 to 40 drops, 
and the tincture (Tinctura Serpentaria, TJ. S. and B. P.) in the dose 
of ^ to 2 drachms. It also enters into Huxham's Tincture of Cinchona 
(Tinctura Cinchonce Composita, TJ. 8. and B. P.). Infusum Serpen- 
tarice, B. P, is given in the dose of 1 to 2 ounces. 



SILICATE OF POTASSIUM OR SODIUM. 

Soluble Glass, or Silicate of Potassium or Sodium, occurs as a clear 
syrupy fluid, and is not official. It is used as a splint in the 
dressing of fractures and sprains, as it rapidly becomes hard and 
immovable when painted over the bandages. Silicate of potassium 
or sodium may be universally substituted for plaster-of-Paris. 

20 



306 DRUGS. 



SOAP. 



Sapo, U. S., Sapo Duris, B. P., is prepared from any alkali and 
fixed oil, although soda and olive oil are most frequently employed 
in the manufacture of the soaps which are used medicinally. Castile 
soap, if good, is the best representative of a pure soap that we have. 

Soap may be cut into the form of a suppository and used to 
provoke movements of the bowel in young children who are suffering 
from constipation, by placing it just iuside the anus, having previously 
dipped it into water one instant to make it slippery. It may also be 
used as an enema, dissolved in warm water, or a mixture known in 
Philadelphia as the " House Mixture " may be employed in the case of 
an adult. This consists of a mixture of water, soft-soap, and molasses 
in varying proportions, and if flatulence is present, turpentine and olive 
oil are added to it. This preparation is as efficient as it is cheap and 
dirty. Soap is also used as an antidote to many poisons and as an 
aid to emetics. 

Green Soap (Sapo Viridis, U. S., Sapo Mollis, B. P.) is not generally 
green, but brown. It is a soft soap made by the use of potash and 
olive oil, and is largely used by dermatologists in the treatment of 
eczema and similar skin diseases where a detergent, stimulating appli- 
cation is needed. It is sometimes called "German soft-soap" to 
separate it from the ordinary soft-soap, or sapo mollis, of this country, 
which is an impure substance often made of rancid fats, containing a 
large excess of alkali and never used except for scouring purposes. 
Green soap is not commonly employed as green soap, but in the tinc- 
ture (Tinctura Saponis Viridis, U. S.), which is to be thoroughly 
rubbed into the part when used medicinally, well washed off, and 
afterward simple cerate or some other soothing salve applied. 

Soap Liniment (Linimentum Saponis, U. S. and B. P.), or Opo- 
deldoc as it is called in domestic medicine, is largely used for rubbing 
stiff muscles and sprains. It is generally employed to carry more 
active external remedies, such as opium or aconite. 

Soap Plaster (Emplastrum Saponis, U. S.) is used as a thick, heavy 
protective in bed-sores or where bed-sores are feared. It is also used 
as a support about sprained joints. 



SODIO-SALIOYLATE OP THEOBROMINE. 

This compound, known as diurelin or sodio-theobromine-salicylate, 
derives its name from the extraordinary power which it is said to 
possess of producing a great increase in the urinary flow from the 
kidneys. This power depends entirely upon the theobromine, which 
is a crystallizable, bitter, and volatile alkaloid, closely allied to caf- 
feine and xanthine, and derived from the seeds of theobroma cacao, or 
the source of ordinary chocolate. Owing to the insolubility of theo- 



SODIUM. 307 

bromine it has been found necessary to combine it with sodium salicy- 
late, as under these conditions it is readily absorbed. 

The diuretic properties of this alkaloid were first discovered during 
a series of experiments made by Schroder in Strasburg in 1889, who 
found that the diuresis produced in man and the lower animals was 
very marked. A large number of clinical trials in Europe and 
America have confirmed his observations, but there are a number of 
cases in which it signally fails, particularly in chronic Bright's disease. 

Theobromine does not have so stimulating an effect on the heart as 
does its relative caffeine, so that the circulatory effect, while showing 
a stimulant rather than a depressing tendency, is very slight. It 
slightly increases muscular power, but its peculiar affinity for the renal 
structures surpasses all its other activities. 

As the action of the drug depends upon its ability to stimulate the 
secreting epithelium of the kidney, the physician should remember 
that in cases of advanced renal disease where the secreting structures 
are almost entirely destroyed no result can be expected from its admin- 
istration; but it is probable that the drug is useful in almost all con- 
ditions of dropsy — whether due to renal inactivity or cardiac disease, 
and is harmless to the patient even if the diuretic effect does not ensue. 
The only 'contra-indication to the use of theobromine or diuretin 
is the presence of acute nephritis, when, of course, sedatives rather 
than stimulants are needed. So far as the writer is aware no study as 
to the proportion of solids and liquids in the urine under the influence 
of this drug have been made, but the fact that it stimulates the epithe- 
lium or secreting structures of the kidney indicates that the solids are 
increased. 

As diuretin only contains from 30 to 50 per cent, of theobromine 
it has to be given in very large amounts, as much as 1 to 2 drachms 
in twenty-four hours, preferably in divided doses of from 10 to 20 
grains in capsule or in warm water. The former method is the better, 
as the taste of the drug is disagreeable and soapy. 

It must not be exposed to the air, as it undergoes decomposition. 

In all the cases in which the writer has tried sodio-salicylate of theo- 
bromine he has failed to see any effect produced, and while he has no 
confidence in the drug mentions it because others claim to have 
obtained good results from its use. 



SODIUM, 

Sodium is a non-metallic element, the salts of which are usually 
white and colorless. It is not used in medicine, but many of its salts 
are employed. Unlike the potassium salts, the salts of sodium seem 
to exert comparatively little effect upon the animal economy. The 
salts vary in their power with the acid forming them. 

Acetate of Sodium (Soclii Acetas, U. S. and B. P.) is rarely if ever 
used in medicine as a substitute for acetate of potassium. Its dose is 
20 to 40 grains three times a day. 



308 DRUGS. 



SODIUM ETHYLATE. 

Sodium Ethylate is a whitish powder decomposed in the presence 
of water into alcohol and caustic soda, but soluble in absolute alcohol 
without decomposition. 

Sodium ethylate is employed in medicine as a depilatory — that is, 
for the purpose of removing hairy growths. To accomplish this pur- 
pose it is Decessary that the growth be clipped close to the skin, and 
that the drug be dissolved in absolute alcohol and applied over the 
roots of the hair with a glass rod. 

Soon after this application a crust forms, which should not be de- 
tached for two or three weeks, but which, on its removal at the end 
of this time, generally shows that all the roots of the hair have been 
destroyed. If not, the operation may be repeated as soon as the skin 
is in a condition to bear it. To prevent pain, a 5 per cent, solu- 
tion of cocaine may be applied. It is worthy of remembrance that 
moles and small birth-marks, or nsevi, may be relieved by a similar 
application. 

SODIUM SULPHATE. 

Sodii Sulphas, U. S. and B. P., or Glauber's Salt, is one of the most 
irritant of the saline purges, rarely used in human medicine, but largely 
employed by veterinarians. The purgative dose for man is half an 
ounce to an ounce. If any intestinal inflammation is present it is 
contra-indicated. It produces large watery stools, with a good deal of 
griping. Sulphate of sodium is a prominent constituent of Carlsbad 
water, Hunyadi Janos, Hunyadi Arpad, and similar waters. 



SOMNAL. 

Somnal is stated to be ethylated chloral-urethan, and seems to 
possess marked hypnotic power. It is a clear, colorless liquid of a 
hot, burning taste, resembling sweet spirit of nitre. The dose is 20 
to 40 drops in liquorice-water or syrup of raspberry, and the sleep 
produced by it is said to last seven to eight hours. The remedy has 
been so recently introduced that no very definite reports have yet 
been made concerning it, but in a number of cases in which the writer 
has used it it has acted very well, although drowsiness is usually present 
on the next day. 

SOZOIODOL. 

Sozoiodol differs in one respect from other antiseptics, so far as our 
patriotism is concerned, in that it was first made and employed by 
one of our own countrymen in San Francisco, but at that time the 
preparation of it was so imperfectly carried out that foreign matters 



SPIGELIA. 309 

made it too irritating for general use, and it was discarded, only to be 
better prepared and more widely used in Germany some years later. 

Therapeutics. — Sozoiodol has been found of value as an antiseptic 
and disinfectant in the treatment of wounds which are in a diseased 
state, and for acute stomatitis and pharyngeal catarrh it may be em- 
ployed locally in the form of a 5 per cent, watery solution. It has 
also been found useful in acute purulent conjunctivitis, and in ophthal- 
mia neonatorum, in the proportion of two parts of sozoiodol to thirty 
parts of water. In urethritis, of a specific type, we may employ the 
preparation known as zinc-sozoiodol in a 2 per cent, solution with 
advantage, and this compound is also of value in mild and malignant 
vaginitis if preceded by pyroligneous acetic acid or nitrate of silver, 
applied by means of a speculum. 

In the treatment of gynecological cases, particularly in catarrh of 
the cervix uteri, Nitschman uses sozoiodol in the form of a powder 
applied by means of a tampon with good results, and it would seem 
to be worthy of trial in many other states of the mucous membranes 
than those just named. 

SPIGELIA. 

Spigelia, U. S., Pinkroot, is the root and rhizome of Spigelia Mari- 
landica, or Carolina Pink, a plant of the southern United States. 

Poisoning. — Almost immediately after the ingestion of a poisonous 
dose of spigelia the animal has short and quick expiratory movements, 
amounting almost to a cough. 1 Soon after, the pupils become widely 
dilated, the eyeball is turned inward, and at the same time the orbit 
becomes very fixed in this position, so that the eye cannot follow any 
object, such as a pencil, when it is moved from side to side. Constant 
retching, with no result, now comes on, the animal standing and appa- 
rently suffering from no sensory or motor palsy. There is no change- 
in gait. Soon after this, marked exophthalmia is developed. The 
retching, having lasted about five minutes, now passes off, and at this 
time signs of muscular weakness and lack of coordination appear, 
the walk becoming staggering both in the fore and hind legs. The 
respirations now become very rapid, resembling those of a dog after a 
long run on a hot day. The tongue hangs from the mouth and is 
dry and red, and the nose is hot and no longer moist. Muscular 
power is progressively lost, so that the dog frequently falls when 
endeavoring to walk, but sensation does not seem to be affected. 
About this period the animal lies down and passes into a deep sleep, 
which, in turn, soon changes into coma, and death follows without 
any movement being made, evidently from a general failure of vital 
force. The respirations, as death approaches, become slow, and are 
finally extinguished simultaneously with cardiac arrest. The palsy is 
spinal in origin, the motor and sensory nerve-trunks and the muscles 
escaping the paralysis. 

1 See investigation by author in The Medical News, March 12, 1887. 



310 DRUGS. 

Therapeutics. — Spigelia is one of the most efficient remedies in the 
treatment of round-worms, and is not dangerous when given with care. 
When employed for the removal of worms the usual precaution should 
be taken in regard to the ingestion of food (see Worms), and it should 
be followed by a purge to sweep out the worm while it is narcotized by 
the drug. The purge should be one which is rapid in its action, such 
as the sulphate of magnesium. 

Administration. — The dose of spigelia, in the form of the fluid ex- 
tract {Extractum Spigelian Fluidum, U. S.) is 2 drachms ; that of the 
unofficial fluid extract of spigelia and senna {Extractum Spigelice et 
Sennce Fluidum) is \ to 1 drachm for a child of two years of age ; \ an 
ounce is the dose for an adult. The addition of fluid extract of senna 
makes the drug more efficient, and the mixture is generally not disliked 
by children. It is to be remembered that this latter mixture is no 
longer official. 

SQUILL. 

Scilla, U. 8. and B. P., is the sliced bulb of Urginea Scilla or Scilla 
Maritima, a plant of the countries bordering on the Mediterranean. 
It contains scillin, scillipikrin, and scillitoxin, all of which possess 
poisonous properties and none of which are used in medicine alone, 
except by a few persons. 

Poisoning. — In poisonous doses squill produces vomiting, purging, 
dulness, stupor, intermittent palsy, convulsions, and death in ten to 
twenty hours. These symptoms are preceded by a great fall in tem- 
perature. The urine is suppressed or bloody, and acute nephritis is 
produced. Gastro-enteritis may be marked. 

Therapeutics. — Squill is largely used as a stimulant or irritant 
diuretic, not to affect the renal epithelium directly and promote secre- 
tion, but rather to tone up and excite to normal effort a kidney 
depressed by disease, as in very chronic B right's disease or renal con- 
gestion from cardiac trouble. In cardiac dropsy, combined with digi- 
talis squill is a standard and much-used remedy, and is undoubtedly 
of value in aiding in the absorption of effusions in the pericardium, 
pleura, and abdomen. Squill is usually given in dropsy, in pill form, 
as follows : 

I£. — Pulv. scillse gr. x. 

Pulv. digital, fol Bj. M. 

Ft. in pil. no. x. S — One t. d. after meals. 

The employment of squill in bronchitis, although largely resorted 
to, is not a very good practice, since its irritant action on the kidneys 
and stomach may cause trouble. The period for its administration is 
in the second stage, when secretion is scauty or so excessive as to need 
proper stimulation of the mucous membranes to bring on a healthy 
action. Sometimes Coxe's Hive Syrup is used, either as an emetic in 
drachm doses every ten minutes until it acts, or as an expectorant in 



STILLINGIA. 311 

the dose of 30 drops to 1 drachm for an adult. As it contains anti- 
mony it should be given with care. 

Administration. — The fluid extract (Extr actum Scillce Fluidum, U. 
S.) is given iu the dose of 1 to 5 drops ; the tincture (Tinctura Scillce, 
U. S. and B. P.), in the dose of 5 to 30 drops ; the vinegar of squill 
(Acetum Scillce, U. S. and B. P.), in the dose of 10 drops to J drachm. 
The compound syrup (Syrmpus Scillce Compositus, U. S.), or Coxe's 
Hive Syrup, is composed of squill, tartrate of antimony and potassium, 
precipitated phosphate of calcium, alcohol, sugar, and water, and is 
given in the dose of 20 drops to 1 drachm. 

The following prescription will be found useful in bronchitis in its 
subacute stages : 

R. — Vini ipecac f^j. 

Tincturse scillse f ^ij. 

Syr. tolutan. ....... f .^v. 

Aquse f^j. M. 

S. — Teaspoonful every three or four hours. 

The plain syrup (Syrupus Scillce, U. S. and B. P.) is given in the 
dose of J to 1 drachm ; the honey (Oxymel Scillce, B. P.), in the dose 
of J to 1 drachm, and the compound pill (Pilula Scillce Composita, 
B. P.), in the dose of 5 to 10 grains. 



STILLINGIA. 

Stillingia, U. S., Queen's Root, is the root of Stillingia Sylvatica, a 
plant of the United States, the active principle of which is stillingin. 

Physiological Action. — There can be no doubt that this drug acts in 
two ways : first, by its immediate effects on the system, and second, 
by its more slowly shown alterative influences. In overdose it causes 
bilious purging, increased heart-action, and active secretion from the 
bronchial mucous membrane. 

Therapeutics. — Stillingia is highly recommended in habitual consti- 
pation, as it increases intestinal secretion, and it is even said to act as a 
specific in haemorrhoids dependent largely for their existence upon 
hepatic engorgement and intestinal atony. 

Bartholow recommends the following prescription under these cir- 
cumstances : 

R. — Extract, stillingise fluid f^v. 

Tincturse belladonna \ 

Tincturse nucis vomicae >- . , aa fgj. M. 

Tincturse physostigmatis J 
S. — Twenty drops in water t. d. before meals. 

Tincture of aloes may also be added to this prescription if consti- 
pation is present. In syphilis of an obstinate and rapid type, stillingia 
should be used as an aid to other drugs. 

In pasty-looking, white, " putty-faced " children, who are anaemic 
or strumous, and who never have any appetite, or are subject to middle- 



312 DRUGS. 

ear trouble and general debility, stillingia is of value. It should be 
used, under these circumstances, for some time. 

The only official preparation is the fluid extract [Extractum Stillin- 
gice Fluidum, TJ. S.), which should always be made of the fresh root, 
the dose of which is 10 to 60 drops. 



STRAMONIUM. 

Jamestown Weed, or Datura Stramonium, is official in the form of 
the leaves (Stramonii Folia, TJ. S.) and the seeds (Stramonii Semen, 
TJ. S. and B. P.). It contains an alkaloid known as daturine, which 
is physiologically identical with atropine. 

Physiological Action. — (See Belladonna.) 

Therapeutics. — The uses of stramonium are identical with those of 
belladonna. 

Administration. — The extract (Extractum Stramonii, TJ. S. and B. P.) 
is used in the dose of ^ to \ grain, the fluid extract [Extractum Stra- 
monii Fluidum, TJ. S.) in the dose of 1 to 5 drops, and the tincture 
(Tinctura Stramonii, TJ. S. and B. P.) in the dose of 5 to 30 drops. 
The ointment ( TJnguentum Stramonii, TJ. S.) is used for the same pur- 
poses as is belladonna ointment. The dose of daturine is T -|-g- to -g^ of 
a grain. 

STRONTIUM. 

This substance has lately been introduced into medicine in the form 
of the bromide, lactate, iodide, and phosphate, largely through the 
studies of Laborde, S6e, Paul, and others. The bromide of strontium 
is used for precisely the same effects as are the other bromides, but it 
is claimed that as the strontium has a distinct nutritive influence over 
the system, the well-known disadvantages of the potassium salt are 
avoided. The dose of bromide of strontium is from 30 to 60 grains. 
In addition to the ordinary effect of bromides See found the bromide 
of strontium to be very useful in overcoming attacks of gastric indiges- 
tion associated with pain in the stomach and hyperacidity, and the 
author has confirmed this statement. The lactate of strontium seems 
to be indicated chiefly in cases of albuminuria due to renal atony. It 
does not increase urinary flow, and is contra -indicated in the presence 
of the uraemia and high fever of acute parenchymatous nephritis. In 
chronic parenchymatous nephritis, such as is due to rheumatism or gout, 
it is of value. Unfortunately, as soon as the lactate of strontium is 
withdrawn, the albuminuria is apt to recur if the disease is not entirely 
cured. The dose of the lactate of strontium is 60 to 100 grains a day. 
Fortunately, strontium possesses no toxic power whatever, and over- 
doses are not followed by any bad consequences. If the strontium is 
contaminated by barium serious effects are produced. 



SUGAR OF MILK. 313 



STROPHANTHUS. 

Strophanthus Hispidus is an African plant from the seed of which 
the natives make Kombe arrow poison. There are many varieties of 
strophanthus. The active principle is strophanthin, from which is 
derived strophanthidin. It has been claimed that strophanthus con- 
tarns a local anaesthetic principle, but Dr. de Schweinitz and the 
author found it to be possessed of this power only in dogs and not in 
man. 

Therapeutics. — Strophanthin may be used in all forms of cardiac 
disease to supplant digitalis, but it is not its equal. 

From the cases of cardiac disease seeu frequently by the writer he 
has reached the conclusion that digitalis gives relief to patients under 
the age of twelve years in a much smaller proportion of cases than it 
does in adults, and that though the stomach is no more frequently 
disordered, increased dyspnoea, nervous irritability, and cyanosis often 
follow its use. 

As everyone knows, there are a certain number of cases where digi- 
talis seems to do harm in adults, the explanation being that under such 
circumstances the ventricle is so overstimulated that the auricle cannot 
empty itself thoroughly, and becomes congested in consequence. 

Strophanthus acts exceedingly well in these instances w 7 here digitalis 
fails, and this is particularly true in adults. It will relieve cardiac 
dropsy by its action on the heart, but is not diuretic in itself. 

Administration. — Strophanthus is given in the form of the tincture 
in the dose of 3 to 6 drops three times a day. Strophanthin may be 
given hypodermically in the dose of y^. to -^ of a grain. Its effects, 
when so used, are said to last a week, but this statement can scarcely 
be correct. 

SUGAR. 

Saccharum, U. S., Saccharum Purificatum, B. P., is the refined juice 
of Saccharum Officinarum, or Sugar Cane, or the juice obtained from 
the sugar beet. It is an anti-putrefactive but not an anti-fermentative. 
Mixed with iron preparatious it prevents oxidation. As it is a hydro- 
carbon it is a nutrient and a developer of adipose tissue, or, in other 
words, is a food. Its use is contra-indicated in obesity, during the 
existence of fermentative changes in the stomach and intestine, and in 
diabetes mellitus. 

SUGAR OF MILK. 

Saccharum Lactis, U. S. and B. P., is derived from the whey of 
cow's milk by evaporation, in the proportion of about 5 per cent., and 
is then purified by re-crystallization. It has little sweetening power 
compared to cane sugar, and possesses a peculiar flat taste. It is, how- 
ever, less apt to ferment and is better for infants than is cane sugar. 



314 DRUGS. 

Milk sugar is largely used in triturations because by its hardness it 
aids in the subdivision of the medicament. It is also used to increase 
the bulk of small powders, where such drugs as podophyllin and calomel 
are prescribed. 

Recent studies, both scientific and clinical, have shown lactose to be 
possessed of very great diuretic power when given in full doses. The 
advantages claimed for lactose as a diuretic is its direct action on the 
kidney and the slight effect exercised upon the rest of the organism. It 
is, therefore, in renal dropsy or renal inactivity that this substance is 
particularly indicated. The dose of lactose in cases of dropsy should 
be as great as from 2 to 4 drachms, given daily, dissolved in a quart 
of water. It has been found that the lactose acts best in those cases 
in which there is no albuminuria. These recent studies are of interest 
in view of the well-known clinical fact that the addition of lactose to 
the milk of bottle-fed babies always causes profuse diuresis. 



SULPHATE OF ZINC. 

Zinci Sulphas, TJ. S. and B. P., is a white, somewhat efflorescent 
salt, of a sharp acid taste, and is soluble in water. In large amounts 
it acts as an irritant, and is employed as an irritant peripheral emetic 
in the dose of 10 to 30 grains. It is not so severe as sulphate of copper 
in its emetic and poisonous properties and may be repeated if the first 
dose does not produce vomiting. In weak solutions it may be used 
as an astringent application in gonorrhoea and other affections of the 
urethral mucous membrane. In 2-grain pills it is sometimes given in 
serous diarrhoeas, particularly if it be combined with opium or minute 
doses of podophyllin (g 1 ^ of a grain at a dose). In conjunctivitis and 
other eye affections the drug is used in the form of a wash. (See 
Conjunctivitis.) 

SULPHIDES. 

Baths of the various sulphides, such as those to be obtained at 
sulphur springs, are very useful in many cases of skin disease of an 
obstinate type, such as psoriasis, lichen, and eczema. They are also 
employed in chronic rheumatism and gout. 

In laryngeal hoarseness and pharyngeal affections, such as follow 
public speaking and exposure to cold, sulphides or sulphur waters are 
very useful, and little doubt, exists but that their persistent employ- 
ment is one of the best means to cure the obstinately atonic state of 
the throat sometimes seen in public speakers. 

As was first noted by Dr. Ringer, the sulphides, particularly in the 
form of calx sulphurata, are very useful in all cases where pus is 
about to form. 

They may be employed in cases where successive crops of boils occur 
and in adenitis of the neck and elsewhere. If they do not stop the 
formation of pus they aid in its inspissation and absorption. Chil- 



SULPHONAL. 315 

dren should take a teaspoonful every hour of a solution containing a 
grain of calx sulphurate, to the half-pint of water. Adults may be 
given sulphide of calcium in gelatin-coated pill, dose J to \ a grain 
three times a day. The solution must be freshly prepared, as it 
undergoes oxidation, changing the drug into a sulphate. 



SULPHONAL. 

Sulphonal is a synthetically prepared substance first manufactured 
in Germany by Baurnann, and possesses the chemical name of diethyl- 
sulphon-dimethyl-methane. It is a colorless, odorless, solid substance, 
soluble in 100 parts of cold and 18 to 20 parts of hot water, and is 
readily soluble in alcohol and ether. The drug is not affected by any 
of the ordinary acids, and is very stable. 

Physiological Action. — Several quite interesting researches upon 
this comparatively new hypnotic have been carried out recently. 
Smith, of Londou, has studied its actiou on the activity of tissue- 
change, and also attempted to determine the changes in the drug 
during its passage through the body. In regard to the first question 
he found, by experimenting upon a powerful, healthy dog, weighing 
thirty-five pounds, which was fed upon one pound of dog-biscuit and 
one quart of water daily, that the amount of urea during the ad- 
ministration of sulphonal is a little greater than that eliminated 
during the period when no drug is given. He also found the urine 
slightly increased in amount under the influence of the drug. The 
changes were, however, so very slight that he reaches the conclusion 
that moderate doses of sulphonal do not affect nitrogenous metabol- 
ism. In regard to the second question Smith quotes the results of 
Kast, namely, that sulphonal does not pass into, the urine as such, but 
in the form of a sulphuretted organic compound. Smith, therefore, 
endeavored to find out whether the entire amount of the drug iugested 
is changed or not. Without taking up space with a full considera- 
tion of his method of experimentation, we find that his conclusions 
may be summed up as follows : In moderate doses the drug is com- 
pletely changed during its passage through the body into a sulphur- 
etted organic substance, and the elimination of sulphuric acid is not 
increased by taking sulphonal. Dr. Smith does not give us the exact 
nature of the substance derived from sulphonal, but promises to in- 
form us further concerning it in a later contribution. Another paper 
upon the physiological action of sulphonal has been published by Dr. 
William F. Shick, of Easton, Pa., who has found, by a series of 
experiments, first, that sulphonal when given by the stomach acts 
very slowly on account of its insolubility; but that subcutaneously in 
warm solution it is much more active. The drug was also found to 
produce a general relaxation of the muscles, and a staggering gait 
after its hypnotic power had passed by. The spectroscope failed to 
show any changes in the blood. The motor nerves were not affected. 
Shick believes that the action of the drug is exerted upon the higher 



316 DRUGS. 

nerve-centres. He also found a decreased reflex activity, and believes 
this lessening to be due to stimulation of Setschenow's reflex inhibi- 
tory centre. On the circulation the drug was found to have but little 
power. When sent directly into the blood there was produced a slight 
decrease in arterial pressure, followed very soon after by an increase. 
Upon the respiration the drug was found to act as a depressant when 
given in full doses. 

Therapeutics. — Sulphonal finds its place in medicine as a somni- 
facient or hypnotic, valuable when functional nervous insomnia is 
present, useless where advanced disease, such as cardiac trouble, is 
responsible for the wakefulness. In insanity it often produces sleep, 
and is of great service in the various mental disturbances charac- 
terized by lack of sleep and often affecting persons of unsound mind. 
Sulphonal may be denned very briefly by anyone who has largely 
used it or watched the reports made of its progress. This definition 
is that the drug does possess sleep-producing power of moderate 
amount — not equal to chloral or potassium bromide, but greater than 
that of paraldehyde, and that it will sometimes succeed where the 
other hypnotics fail. 

Administration. — Sulphonal being virtually insoluble in cold water, 
it may be given in large capsules or in mucilage of acacia, so as to 
be held in suspension until swallowed. The insolubility and bulki- 
ness of the drug render its use difficult. It is best given in hot water 
(about 6 ounces), as suggested by Stewart. This makes a solution, 
and as soon as the liquid is cool enough to be swallowed, it should be 
taken before precipitation occurs as the result of cooling. The dose 
is 20 to 40 grains. 

SULPHUR. 

Sulphur is a non-metallic element official in three forms in the 
TJ. S. P., namely, as Sulphur Sublimatum, or sublimed or flowers of 
sulphur, Sulphur Precipitatum, U. S. and B. P., or precipitated sul- 
phur, and Sulphur Lotum, or washed sulphur. 

Much confusion exists among students as to the differences between 
these various forms of sulphur. Sulphur itself is an element which 
is prepared for medicinal uses by being heated and sublimed (Sulphur 
Sublimatum), or flowers of sulphur. Sulphur lotum, or washed sul- 
phur, is prepared in order to get rid of sulphuric acid and other con- 
taminating substances, and is made from sublimed sulphur. Sulphur 
precipitatum is also made from sublimed sulphur, and is more bland 
and minutely subdivided. Some suppose it to differ from sublimed 
sulphur in its therapeutic properties, by reason of a small amount of 
water supposed to be present. It is sometimes called milk of sulphur. 
When sulphur is prescribed for internal use the sublimed sulphur is 
generally designated. 

Physiological Action. — Sulphur has little physiological influence over 
the general system. When taken internally it causes a soft, mushy 
stool of a yellow color, with a strong odor of hydrogen sulphide. The 



SULPHUR. 317 

drug acts particularly on the skin and mucous membranes. The juices 
of the intestines break up some of it into sulphuretted hydrogen and 
sulphides. 

Therapeutics. — Sulphur is used as a mild laxative, never as a purge. 
In stricture of the bowels the soft stools produced by it will often slip 
by the obstruction, and it is worthy of note that sulphur will some- 
times overcome constipation when nothing else will give relief. It is 
particularly valuable in the treatment of constipation where there are 
haemorrhoids, and in chronic rheumatism and sciatica it is thought by 
some to effect a cure. 

Sulphur is of great service in the treatment of chronic bronchial 
affections, but for some curious reason its use has become almost obso- 
lete. The so-called Bergeon's method of treating phthisis by rectal 
injections of carbonic acid gas loaded with sulphuretted hydrogen was 
simply a revival of a custom of our great-grandfathers who often used 
sulphur waters by the mouth in the treatment of catarrhs or other dis- 
orders of mucous membranes. Bergeon took the trouble to go to the 
back door to accomplish what was done 200 years ago by the front 
door, and the only novel part of his method was his filthy way of using 
the drug. Graves recommended 5 to 10 grains of sulphur three times 
a day wherever bronchial secretion was excessive, and found that it 
rid the lungs of mucus and relieved the cough. 

The external use of sulphur is very much more important than its 
internal use, in so far as regards affections of the skin. Of itself the 
drug exercises little effect over the cuticle when used in powdered form, 
but combination with an ointment makes it at once active. Even irrita- 
tions of the skin may ensue from its constant use in concentrated form. 

In scabies, or itch, sulphur ointment ( Unguentum Sulphuris, U. 8. 
and B. P.) is the best remedy we have. The female parasite burrows 
under the epiderm and deposits the ova as she moves about, while the 
male does not burrow but stays on the surface. The ointment will 
kill him, as he is readily attacked, but the female is protected by her 
burrowing propensities. To get at her and the ova the burrows must 
be opened, and this may be accomplished by a thorough soaking of 
the body with soap and water, thereby softening the epiderm covering 
the parasite, which can then readily be removed by rubbing the patient 
with a rough towel. The towel should be boiled at once to prevent 
its conveying the parasite to others. The ointment, if now applied, 
relieves the patient almost at once. It is important that the skin be 
well softened and rubbed, in order to keep open every burrow. The 
ointment should be allowed to remain on the part all night and be used 
for three or four nights consecutively. 

Young women often suffer from acne, particularly about the men- 
strual epoch, the skin also becoming at this time sallow and muddy. 
Ringer recommends the following lotion as one which is very successful 
in promoting a cure : 

R. — Sulphuris sublimati #j. 

Glycerini f^j. 

Aquae rosse f^viij. M. 

S. — Apply as a wash once or twice daily. 



318 DRUGS. 

Administration. — Sulphur is given in the dose of 10 to 20 grains 
three times a day as an alterative, and from 1 to 2 drachms at night 
as a laxative with a little molasses to form a paste. 

A confection (Confectio Sulphuris) is official in the B. P., dose 
10 grains to 2 drachms. 

Sulphide of Calcium. 
(See Calcium, Calx, and Sulphides.) 

SULPHURIC ACID. 

Acidum Sulphuricum, U. 8. and B. P., Sulphuric Acid, or Oil of 
Vitriol, is a powerful irritant and escharotic, rapidly dehydrating and 
carbonizing the tissues, causing them to become black. It is the 
most astringent of the mineral acids, and when absorbed is converted 
into sulphates and so eliminated by the kidneys, the lower bowel, and 
the skin. 

Poisoning*. — The symptoms produced by poisonous doses are those 
of a gastro-intestinal inflammation of the most severe type, or the 
patient may drop to the floor almost at once owing to collapse, depend- 
ent upon perforation of the walls of the oesophagus or stomach by the 
acid and its consequent escape into the peritoneal cavity. If the 
patient lives to the fourth day the parotid glands may become swollen, 
as the result of stenosis of the salivary ducts of Steno, and violent 
inflammation of the kidneys may appear from the passage of the 
drug through these organs in the process of elimination. If partial 
recovery takes place the patient often dies from inanition due to the 
formation of strictures in the alimentary canal or to destruction 
of the peptic tubules. The stain about the mouth is black, and if 
any of the acid is spilt on the clothes, the characteristic burn is to 
be seen. 

The treatment consists in the use of alkalies, such as chalk, mag- 
nesium, whitewash off the walls, and soap. Opium and oils are to 
be given to allay irritation, and external heat is to be applied. 

Therapeutics. — Sulphuric acid is sometimes employed as a caustic 
to venereal sores, warts, and sloidy healing ulcers, but is most commonly 
used internally, as it fulfils several pressing indications. As a remedy 
for serous diarrhoea, particularly if combined with some vegetable 
astringent, it is unsurpassed, and its use in cholera deserves great 
attention. (See Diarrhoea.) In the Philadelphia Hospital during 
an epidemic of cholera some years since, every case which received 
it improved or failed to be attacked, whereas those who did not 
receive it were either very ill or died. 

The proper way to use the drug as a prophylactic during cholera 
epidemics is in the form of " sulphuric-acid lemonade," made so that 
each wineglassful of water contains 5 drops of the aromatic sulphuric 
acid. The same solution may be used in acute lead-poisoning in order 



SWEET SPIRIT OF NITRE. 319 

to form an insoluble sulphate of lead, and may be taken by artisans 
exposed to chronic lead-poisoning as a prophylactic for the same 
reason. 

As sulphuric acid is eliminated by the skin it is often useful in the 
night- sweats of phthisis combined with belladonna or morphine. 

Administration. — The dose of the dilute acid (Acidum Sulphuricum 
Dilutum, U. S. and B. P.) is 10 to 20 drops, and of the aromatic acid 
[Acidum Sulphuricum Aromaticum, U. S. and B. P.) 5 to 20 drops. 
The latter is the best preparation for general use. Both should be 
thoroughly diluted before they are administered. 



SUMBUL. 

Sumbul, U. S., is the root of Ferula Sumbul, a large plant of 
Northern Asia. The dose of the root (Sumbid Radix, B. P.) is 10 to 
40 grains. On the nervous system sumbul acts as an efficient nerve 
tonic, and is very largely employed by Goodell in cases of nervous 
exhaustion and in the unrest of nervous females. It is official in the 
tincture (linctura Sumbid, U. S. and B. P.), dose 1 to 4 drachms. 
Goodell uses the following formula : 

R. — Extract, sumbul. . . . . . gr xx. 

Ferri sulph. exsiccat. . . . . gr. xx. 

Asafoetidse . . . . . . . gr x. 

Acid, arseniosi gr. ^ M. 

Ft. in pil. no. xx. S. — One t. d. after meals. 

To be of any value the drug must be fresh and care must be taken 
that the crude drug from which it is made is a good sample. 



SWEET SPIRIT OF NITRE. 

Sweet Spirit of Nitre (Spiritus JEtheris Nitrosi, U. S., and B. P.), 
or Spirit of Nitrous Ether, is a mixture of alcohol, water, and ethyl 
nitrite. It is upon this last constituent that most of its value as a 
remedial agent depends. The drug when sold by pharmacists or 
others who are not very careful to keep fresh preparations is no better 
than alcohol and water alone, since the ethyl nitrite readily escapes, 
and deterioration at once takes place. Until recently the profession 
have had no ready means of protecting themselves from such poor 
preparations, but at present we know that all that is necessary is to add 
a grain or two of antipyrine to a half- ounce or less of the spirit. If 
the ethyl nitrite be present a purple color followed by a green precipi- 
tate will be found. This green precipitate is iso-nitroso-antipyrine, 
which is not in the least poisonous. 

Physiological Action. — Sweet spirit of nitre is a sedative to the cir- 
culatory and nervous system and a diaphoretic and diuretic according 
to the manner in which it is administered. 

If given in very full doses it rapidly produces the cyanosis char- 



320 DRUGS. 

acteristic of the full effects of any one of the nitrites. (See Amyl 
Nitrite.) 

Therapeutics. — There is probably no drug so widely employed by 
the laity as a household remedy which is so potent for good and yet so 
harmless, if wrongly used, as is this one. 

Physicians often place less reliance upon it than it deserves, and 
in nearly every instance where it fails it is either not indicated or the 
nitrite has escaped and left it powerless. 

In incontinence of urine in children the combination which follows 
is very useful in certain cases. (See Incontinence of Urine.) In these 
instances the urine will be found high-colored and concentrated, and 
therefore capable of irritating the bladder and genito-urinary tract. 

R. — Potassii citratis ^j to gij. 

Spt. aetheris nitrosi f,|ss. 

Aquae q. s. ad fjiv. M. 

S. — Dessertspoonful every five hours until the urine becomes clear. 

As soon as the urine is clear belladonua may be used ; the citrate 
of potassium and spirit of nitre being continued, or not, as the case 
demands. 

Where the spinal centres are depressed and there is general atony 
of the system it may be well to substitute the following pill for the 
belladonna : 

R . — Acid, arseniosi gr. |-. 

Extract, nucis vomicae . . . . gr. ij. 

Quininae sulphatis . . . . . gr. xx. M. 

Ft. in pil. no. xx. S. — One pill t. d. after meals. 

The diuretic action of sweet spirit of nitre is best obtained by using 
the drug in ice-cold water and keeping the patient lightly covered and 
cool. On the other hand, if a diaphoretic influence is desired it may 
be given simultaneously with warm lemonade, and the patient should 
be well blanketed. This last action of sweet spirit of nitre has made 
it a remedy of common use in treating acute colds in adults and 
children, and in setting aside the fever of these conditions in the 
latter class as well. 

Sweet spirit of nitre is a distinct antispasmodic, and can be well em- 
ployed where slight nervous excitement accompanies fevers or in other 
states associated with irritation in infancy. 

The dose for an adult is from 20 drops to 1 drachm, and for a 
child of one year 5 to 10 drops. It should always be given in cool 
water to this class of patients. 



TAMARINDS. 

Tamarindus, U. 8. and B. P., is the preserved pulp of Tamarindus 
Indica, a tree of the West Indies. 

The taste is a peculiar mixture of bitter and sweet. As a laxative 
it exerts little power over that of any ordinary fruits, such as apples, 



TANNIC ACID. 321 

but it enters into the confection of senna (Confectio Sennce, U. S. and 
B. P.). Patients often find tarmarinds a very agreeable laxative when 
they are taken before going to bed or eaten as a confection after meals. 



TANNIC ACID. 

This acid when pure is an uncrystallizable, white or yellowish-white 
powder without bitter taste and very soluble in water or glycerin. It 
is not so soluble in alcohol and ether. It is the chief active principle 
of vegetable astringents, and occupies the relative position of an alka- 
loid to a crude drug, so far as the active portion of these vegetable 
astringents is concerned. 

Physiological Action. — Tannic acid when brought in contact with 
any of the tissues of the body constringes them and decreases their 
vascularity for a time, by causing contraction of their bloodvessels. 
For these reasons it stops secretion and condenses parts of the body 
which are relaxed and feeble. Mixed with blood it forms a clot with 
great rapidity through coagulation of the albumin. Tannic acid is 
absorbed as gallic acid and eliminated as such, only acting as tannic 
acid before absorption. This is important to 'remember, since we 
learn from this that tannic acid is to be used to check haemorrhage only 
where the drug can be brought in direct contact with the bleeding 
point. If a haemorrhage is to be reached through the circulation, as 
in renal bleeding, gallic acid is to be given, as it is absorbed at once 
without change. 

Therapeutics. — Tannic acid is used in medicine to control haemor- 
rhage, and to act as an astringent to relaxed tissues as in diarrhoea of 
the atonic or serous type, or in localized or general sweating. It is 
also of service for the purposes of toughening mucous membranes or 
parts of the skin which are exposed to much rubbing, as in the case 
of the nipples of a primipara, or where the feet become macerated 
and sore, or sweat profusely on exercise being taken. In the treat- 
ment of haemoptysis, tannic acid may be dissolved in water in the 
proportion of 5 to 10 grains to the ounce and used as a fine spray. 
Glycerite of tannin is made by adding 2 troy ounces of tannic acid 
to a J pint of glycerin and mixing at a gentle heat until solution 
occurs. It is useful as an application to slow ulcers and depressed 
mucous membranes, as after an attack of stomatitis. In haemorrhoids 
of the bleeding type tannic acid suppositories are often very useful, and 
cotton saturated with tannic acid solution is often used as a packing in 
vaginal leucorrhoea. 

Administration. — The dose of tannic acid is 2 to 10 grains, best given 
in pill. The official preparations are : the troches (Trochisci Acidi 
Tannici, U. S.), each containing 1 grain of tannin, and an ointment 
( Unguentum Acidi Tannici). The B. P. preparations are Glycerinum 
Acidi Tannici ; Suppositoria Acidi Tannici, each containing 3 grains, 
and Trochisci Acidi Tannici, of which each contaius J grain of the acid. 

21 



322 DRUGS 



TANSY. 



Tansy ( Tanacetum, U. S.). The leaves and tops of Tanacetum Vulgar e 
yield a volatile oil (Oleum Tanacetum) which possesses emmenagogue 
powers and has been largely used as a uterine stimulant. It is also 
used as an anthelmintic. 

In poisonous dose it causes epileptiform convulsions in some cases, 
and deep coma, with death from respiratory failure. 

The dose of the oil as an emmenagogue is 1 to 3 drops. 

In domestic medicine tansy tea, made by adding 1 ounce of the 
leaves or tops to 1 pint of water, and given in the dose of 1 to 2 
ounces, is largely employed as a remedy for amenorrhoea. 



TAR. 

(See page 284.) 



TARAXACUM. 

Taraxacum, U. S., Dandelion, is a very old remedy for hepatic 
torpor and the dyspepsia resulting therefrom. It should be pre- 
pared from the fresh leaves or roots, as the dried stale plant is inert. 
From disregard of this fact much disappointment has arisen. Owing 
to its being bitter it acts as a tonic. The extract (Extractum Tarax- 
aci, U. S. and B. P.), dose 5 to 30 grains, and the fluid extract (Ex- 
tractum Taraxaci Fluidum, U. S.), dose 1 to 3 drachms, are the only 
official preparations. Succus Taraxaci, B. P., is given in the dose of 
1 to 2 drachms ; Decoctum Taraxaci, B. P., is administered in the 
dose of 2 to 4 ounces. 

TARTARIC ACID. 

Acidum Tartaricum, U. S. and B. P., is a vegetable acid much less 
powerful than acetic acid, but capable of producing very severe gastro- 
enteritis if taken in overdose and in concentrated form. It is rarely 
used alone and is most commonly employed to act upon sodium or 
potassium bicarbonate to form effervescent drinks. (See Seidlitz 
Powder and Effervescing Draught.) The dose is 5 to 20 grains. 

When tartaric acid is taken in poisonous dose, lime-water, alkalies, 
and magnesium are the antidotes, and opium is to be given to allay 
irritation. If necessary, emetics are to be used. 



TEREBENE. 

Terebene is a liquid substance, clear, colorless, insoluble in water, 
having a peculiar odor like that of new pine sawdust, and is made by 



TEKPINOL. 323 

the action of sulphuric acid upon oil of turpentine, which is then dis- 
tilled at about 160° F. 

Therapeutics. — Terebene is a very useful stimulating expectorant, 
to be used in the late stages of acute or in chronic bronchitis to liquefy 
and get rid of the mucus which is clogging the bronchial tubes. The 
drug may be given by way of the stomach or by inhalation. A useful 
mixture in the later stages of bronchitis when the mucus is very thick 
and tenacious is one composed of equal parts of terebene, iodide of 
ethyl, and chloroform, placed on a sponge and held some two or three 
inches from the face. It has also been employed in genito-urinary 
inflammations of a subacute or chronic form in place of oil of sandal- 
wood or copaiba as a stimulant. In fermentative dyspepsia it is of 
service as an antiseptic. The drug should always be given in capsules 
in the dose of 5 to 10 minims, or by dropping it on sugar in the same 
amount. This dose may be repeated every three hours. Unfortunately 
terebene is very apt to irritate the stomach or to produce diarrhoea, 
and it sometimes irritates the kidneys. 

TERPINE HYDRATE. 

Terpine hydrate is prepared by a certain process, unnecessary to 
explain, from a mixture of pure oil of turpentine, alcohol, and nitric 
acid. In this manner large, colorless crystals, without odor, and with 
a faint taste, are formed, and in this form the drug appears on the 
market. Terpine hydrate is soluble in 250 parts of cold, 32 parts of 
boiling water, and in ten parts of alcohol. In ether it requires 100 
parts for its solution and in chloroform 200 parts. 

Therapeutics. — Terpine hydrate is used for the purpose of increas- 
ing secretion from the bronchial mucous membrane, and is a useful 
remedy in subacute or chronic bronchitis to rid the tubes of mucus. 
The drug has also been satisfactorily employed in the treatment of 
hay fever when given in full doses. The remedy, while only useful 
in a limited number of conditions, certainly seems to be very useful 
in the varieties of disease named. The dose as generally given is 2 
to 3 grains, but it may be given in the dose of 15 to 20 grains three 
times a day in hay fever. Terpine hydrate may be prescribed in pills, 
capsules, and in alcoholic solution, flavored with some of the aromatic 
waters, and with the addition of a little syrup. 

TERPINOL. 

Terpinol is derived from terpine hydrate by boiling the latter with 
dilute mineral acids. Terpinol occurs as an oily substance, smelling 
like hyacinths. It is almost insoluble in water, but dissolves readily 
in ether and alcohol. It is used for precisely the same purposes as 
terpine hydrate, in the dose of 8 to 20 grains, in capsules or pills. 
This dose may be given twice or thrice a day. The drug may irritate 
the stomach and kidneys when given in overdose. 



324 DRUGS. 



THALLIN. 



Thallin is a synthetically prepared chemical compound otherwise 
known as Parachinanisol. There are three salts of thallin : the 
sulphate, the tartrate, and the hydrochlorate. All are alike in 
appearance and taste, but the sulphate is generally employed. Given 
to man in a healthy state they produce an unpleasant taste in the 
mouth, but no other symptoms unless the dose be quite large. Buzzing 
in the ears, labored respiration, deep cyanosis and coma come on after 
excessive amounts are taken. 

Physiological Action. Nervous System. — So far as is known, 
the influence of this drug over the nerves amounts to almost nothing. 
No studies are on record which show any such direct influence. 

Circulation — Upon the circulation thallin has little influence, in 
moderate dose, although its tendency is toward depression rather than 
stimulation. In very large doses it lowers blood-pressure by depressing 
the heart and peripheral vasomotor system. 

Temperature. — Thallin reduces normal bodily temperature very 
slightly, and lowers febrile temperature by increasing the dissipation 
of heat. 

Tissue-waste and Urine. — It increases the urinary flow, but its 
action on tissue-waste is uncertain. 

Antiseptic Action. — It possesses more antiseptic power than other 
antipyretics, and 1 per cent, solutions prevent fermentation in organic 
liquids for some time. 

Prolonged Poisoning. — In prolonged poisoning the drug causes 
degenerative changes in the kidneys and a decrease in the number of 
the red blood-corpuscles. 

Therapeutics. — Thallin has never obtained much hold upon pro- 
fessional favor for reasons not very easy to perceive. The studies of 
Minot seem worthy of special mention as in reality outlining the 
general opinion and thought of the practitioners on this side of the 
Atlantic in regard to this drug. Minot found that thallin acted more 
satisfactorily and with the most lasting effect when it was given at or 
just before the acme of a febrile process. The effects of the drug 
were always most favorable, sweating and vomiting occurring but a 
few times, while in many instances the patient, previously restless and 
delirious, became tranquil and quiet. It was also found by Minot 
that the drug exercises no appreciable influence upon the duration of 
the disease in typhoid fever, and he concludes that it is sufficiently 
harmless to be given to very young children. 

The writer's experience with thallin is too limited to permit of his 
speaking authoritatively concerning it, and he can therefore merely 
state that it has always seemed to him far less useful in fevers than 
many of the other drugs of its class. The fact that its influence is so 
transient, lasting only from two to three hours as a rule, the necessity 
of its frequent dosage in consequence, and its liability to nauseate the 
patient by reason of its taste and action on the stomach, are all against 



THIOL. 325 

its use. Of the fact that it acts quite as rapidly, if not more so, than 
antipyrine and acetanilide, there can be no doubt* It has been found, 
too, that the sweat is often very excessive, although there are some 
observers who assert that, in children particularly, this symptom is 
often absent. Jaccoud thinks that so many people have an idiosyn- 
crasy to its use that small doses should always be used at first. 

Owing to the transitory effects of the drug frequent administration 
of the remedy is necessary, and as this fact was first pointed out by 
Ehrlich, the term " thallinization of Ehrlich" is frequently heard 
when the use of the drug is spoken of. The dose under these circum- 
stances should be given hourly in the amount of \ to 1 grain, or even 
2 grains in adults. 

THAPSIA. 

Thapsia Garganica is an umbelliferous plant of Southeastern Europe 
employed for the purpose of producing a blister. It is generally used 
under these circumstances in the form of a plaster. The resin, obtained 
from the bark of the root, is the form in which it appears in medicine. 
When applied continuously it produces great irritation and finally 
sloughs appear. 

THIOL. 

Thiol is a substance introduced into medicine as a substitute for 
ichthyol, which possesses the disadvantage of having a disagreeable 
odor. It is derived from brown-colored paraffin or gas oils by a com- 
plicated process. The product obtained is evaporated in vaeuo to a 
thin extract called thiolum liquidum, or still further to dryness, or thi- 
olum sicca. The liquid thiol occurs as a thin brownish-black neutral 
fluid, smelling slightly like birch oil. It is slightly soluble in alcohol and 
ether, but quite soluble in water, forming a clear mixture, which is 
rendered more perfect by the addition of glycerin. Thiol sicca may 
appear in lustrous scales. 

Therapeutics. — The question which arises at once in regard to thiol 
is, whether the fact that thiol is practically an artificial ichthyol 
necessarily indicates that it can be used as a substitute for that sub- 
stance. While it is true that they are both sulphur compounds, it is 
also true that ichthyol possesses very extraordinary powers not met 
with in any other form of sulphur previously known. Thiol has been 
used largely by skilful observers in diseases of the skin in moist eczema, 
scrofulosis of the shin, and in syphilides with asserted good results. In 
cases of moist eczema the thiol is used, after first washing the part with 
an antiseptic solution, by dusting it over in powder form. Bidder has 
treated the disease by using compresses wet with thiol in 10 per cent, 
solution. 

While it is claimed that thiol will relieve exudations about joints 
and elsewhere in as effective a manner as ichthyol, sufficient evidence as 
to this point is not yet before us. Thiol is much cheaper than ichthyol. 



326 DRUGS. 



THYMOL. 



Thymol, U. S. and B. P., is derived from the oil of thyme and 
other volatile oils, and occurs in large crystals. It is almost insoluble 
in water, but is freely so in fats and oils. Thymol is irritant, but 
antiseptic and disinfectant, and has been employed in typhoid fever 
as an intestinal antiseptic by Henry and others. In the treatment of 
stomatitis or tenderness of the gums after mercurialization the follow- 
ing mouth-wash may be used : 

J&. — Thymol gr. x. 

Sodii boratis . gr. xv. 

Aquse f^ij. M. 

S. — Place a teaspoonful of this in half a tumblerful of water and use as a gargle. 

It has been used for dressing wounds, but is too costly. In sum- 
mer weather it cannot be employed, because of its attraction to flies, 
which make the patient's life miserable. The dose is J to 2 grains, 
in capsule or in wafer, and it is better to follow its use by a glass of 
milk to prevent the drug from irritating the stomach. In typhoid 
fever as much as 30 grains in twenty- four hours may be given. 

If very large amounts (100 grains) are taken in a day, poisoning 
may result, but as much as this must be used before danger is present. 



THYMOL IODIDE. 

This compound of iodine and thymol, sometimes called aristol, but 
more correctly dithymol diodide, has been introduced into medicine 
for the purpose of substituting iodoform. It does not possess the 
unpleasant odor of iodoform, and it is stated to be less apt to produce 
poisoning by absorption. A great deal of contradictory experience 
has accumulated as to its exact value, but the result of a careful ex- 
amination of clinical reports is that in some respects it is a better drug 
than iodoform and in others not so good. Tichhoff and !N"eisser state 
that when taken internally thymol iodide is incapable of causing 
toxaemia, but this can only be true when moderately large doses are 
given. Upon cocci and bacilli thymol iodide has less power than 
iodoform. In regard to the power of this drug in healing wounds 
or sores, the decision has been reached that whenever secretion is free 
it is contra-indicated, as the thymol seems to increase moisture. On 
the other hand, in those instances where in disease of the skin or 
mucous membrane an undue dryness is present the effect produced is 
often favorable. Upon lupus littb effect is produced unless the sur- 
face is first curetted. Finely powdered thymol iodide has been found 
of very unusual value in the treatment of interstitial keratitis by De 
Schweinitz and Wallace when dusted into the eye each day. In an 
ointment of J to 1 drachm to the ounce of lard, thymol iodide may 
be used in psoriasis, but it is not as useful as is chrysarobin in this 
affection. 



TURPENTINE. 327 



TOBACCO. 



Tabacum, U. S. (Tabacum Folia, B. P.), is the dried leaves of 
Nicotiana Tabacum, a native of tropical America, but cultivated all 
over the temperate zone. It contains a liquid alkaloid, nicotine, but 
dose not contain nicotianin, as no such principle exists. 1 When 
smoked it yields pyridine, which is sometimes used in medicine by 
itself. 

Physiological Action. — Tobacco, in overdose, is a nauseating emetic, 
very depressant in its influence on respiration and the circulation. 
The pupils are contracted by its influence, the bodily temperature is 
lowered, and the skin becomes cold and clammy. 

Upon the motor nerves tobacco acts as a depressant poison. 

Nicotine is one of the most violent poisons known, and is almost 
as fatal as hydrocyanic acid, death having taken place iu three minutes 
after the ingestion of a poisonous amount. 

The drug, when smoked or chewed to any extent by young persons, 
stunts the growth of all parts of the body, and is very apt to cause, 
in all persons, granular sore-throat, pharyngitis, laryngitis, and fau- 
citis. Sometimes angina pectoris is developed. u Tobacco heart" is a 
term applied to a condition of this viscus characterized by disorders 
in its rhythm or power ; palpitation, arhythmia, and dyspnoea being 
often present. 

The treatment of poisoning by tobacco consists in the use of 
strychnine to stimulate the nervous system and the respiratory centre, 
and in the employment of cardiac stimulants, external heat, aud 
atropine. 

In the mild form of poisoning, following excessive smoking, in 
which slight nausea is felt, the author has found 1 to 2 drachms of 
Hoffmann's Anodyne taken in ice- water most effective. 

Therapeutics. — Tobacco is used to relieve constipation by some 
practitioners, and for this purpose the Avine ( Vinum Tabaci) is usually 
employed in the dose of 10 miniuis every night on retiring to bed. 
The drug has been employed in many affections, such as asthma, intes- 
tinal obstruction, and dropsy, but has passed into disuse because the 
symptoms produced were often excessively severe and very serious to 
the patient. Applied in solution to pruritus ani and vulvae tobacco is 
frequently of service, but absorption may occur and produce untoward 
effects. It ought not to be used on piles for this reason. 



TURPENTINE. 

Tei^ebinthina, U. 8., occurs in two forms, namely, as turpentine 
derived from the ordinary yellow pine {Pinus Australis) and other 
varieties of pine, and as turpentine derived from Abies Balsamea, or' 

1 See authors Prize Essay on Tobacco. Philadelphia, 1885. 



328 DRUGS. 

silver fir, or species of cone-bearing trees other than Pinus Australis. 
The turpentine derived from the latter sources is sometimes called 
" Balm of Gilead." 

Much confusion often exists in students' minds as to the difference 
between oil of turpentine (Oleum Terebinthince, TJ. 8. and B. P.) and 
spirit of turpentine, both of which are the same substance under a 
different name. This oil is not, however, the same thing as " turpen- 
tine," for the oil is distilled from turpentine. The distilled oil is a 
thin, clear fluid, having a peculiar odor and taste, and is irritant to 
the skin and mucous membranes. It is exceedingly inflammable, 
should never be placed near a light, and if added to any strong min- 
eral acid takes fire. 

When turpentine is spoken of in this book, or in medicine generally, 
the oil of turpentine is what is meant unless the contrary is stated. 

Physiological Action. — Turpentine, when taken internally, produces 
a sense of warmth in the stomach, a quickened pulse, a warm skin, 
and slightly accelerated breathing. In overdose it may cause intoxica- 
tion. Upon the circulation it produces a very slight rise of arterial 
pressure, increased pulse-rate, and increased heart-force. On the ner- 
vous system the drug, in large amounts, causes loss of sensation before 
voluntary motion. 

The drug is eliminated by the kidneys and lungs, and gives the 
odor of violets to the urine. 

Poisonous doses cause strangury, bloody urine, renal inflammation, 
and cyanosis, with dilated pupils and gastro-enteritis. 

Therapeutics. External Use. — Turpentine is used as a local 
application for the purpose of producing counter-irritation over any 
area where deep-seated inflammation exists. Under these circumstances 
it is almost always used in the form of a stupe, made as follows : Place 
a tin cup containing the turpentine in a vessel containing hot water so 
that the turpentine may be warmed without coming near a flame. 
Dip a piece of flannel into very hot water and wring it out in a 
twisted towel, and, when it is so dry that no water drips from it, dip 
it into the hot turpentine and wring it out again to free it from any 
excess of the drug. The cloth, while hot, should be applied, and 
allowed to remain until discomfort ensues, when it should be with- 
drawn, as it will blister the skin if left on too long. In children and 
adults turpentine may be rubbed on the chest in bronchitis with much 
relief, but in the former class it should be diluted with sweet oil, half 
and half, or even two-thirds of oil. 

Internal Use. — Turpentine is used internally as a stimulant of a 
diffusible type in the course of the exhausting fevers, particularly if 
any flatulence exists or if any ulceration of the bowels is present. In 
typhoid fever turpentine stupes, turpentine enemata, and the adminis- 
tration of the drug by the mouth, are the best ways to overcome tym- 
panites. At the end of the second week, when the tongue is red, dry, 
cracked, and brown, the teeth covered with sordes, and tympany is 
well marked, turpentine should be used in emulsion in the dose of 5 
in 10 drops three times a day. Again, in convalescence from typhoid 



TURPENTINE. 



329 



fever, when diarrhoea is persistent and relapses are constant and due 
to an unhealed state of Peyer's patches, turpentine is the remedy par 
excellence. 

In intestinal and other passive hemorrhages, such as menorrhagia, 
the drug is often of service. 

Used against the tape-worm, turpentine is given in the dose of half 
an ounce to an ounce mixed with an equal amount of castor oil. This 
is a someAvhat dangerous practice, but is efficient. In chronic and 
well-advanced kidney disease very large doses of powerful diuretics 
are often required to stimulate the kidneys sufficiently to cause urinary 
flow, and turpentine may be used under these circumstances. 

Turpentine is contra-indicated in any acute inflammation of the 
gastro-intestinal tract and in acute nephritis. 

In lumbago the dose of 20 drops is said to be very useful, and many 
have found it of value when inhaled from boiling water in bronchitis 
of a subacute or chronic form. In gleet it is given by the mouth to 
stimulate the genito-urinary tract. Turpentine should be tried in the 
treatment of purpura hemorrhagica, as it has been found of value. 

Administration. — Turpentine may be given for the relief of flatu- 
lence by placing 5 drops on a piece of sugar or in emulsion made by 
using acacia and a flavoring substance, as follows : 

R • — 01. cinnamomi gtt. xx. 

01. terebinthinee . . . . . . fsjiv. 

Mucil. acacise . . . . q. s. ad fjiv. M. 

S. — A teaspoonful every four hours in typhoid fever. 

A more agreeable preparation, not to be used in typhoid fever, is 
that recommended by Bartholow, as follows : 



R . — Olei terebinthinee 

Olei amygdal. expres, 
Tincturas opii 
Mucil. acaciae 
Aquae lauro-cerasi 
S. — A teaspoonful every four hours for tympanites. 

When used as an enema, the following is useful : 

R . — Olei terebinthinse 
Olei olivae . 
Camphorae . 
Mucil. acacia? 
Aquae 

S. — To be injected as an enema for the relief of 
removal of hardened faeces. 



fgffl. 

f^ij- 

f^v. 

f ?ss. 



M. 



. f: 

. fgx M. 

ympanites and to aid in the 



The Liniment of Turpentine (Linimentum Terebinthince, U. S. and 
£. P.) is largely used as a stimulating application to sprains and en- 
larged joints. 

Turpentine is of service in ring-worm, applied with a brush to the 
part affected. The following preparations are official in the B. P, : 
Confectio Terebinthince, dose 1 to 2 drachms ; Enema Terebinthince f 
Unguentum Terebinthino3, and Linimentum Terebinthince Aceticum. 



330 DRUGS. 

The ointment is used as a counter-irritant and stimulant to the part 
to which it is applied. The liniment acts in the same way when 
applied to sprains and bruises. 



UVA URSI. 

Uva Ursi, U. S., Bearberry, is the leaves of Arctostaphylos Uva 
Ursi, a widely distributed evergreen shrub. The drug is known in 
the B. P. as Uvce Ursi Folia. Its active principle is arbutin, some- 
times called ursin. 

Therapeutics. — Uva ursi is employed in medicine as a weak, astrin- 
gent diuretic, possessing alterative power over the genito-urinary ap- 
paratus. It is used in pyelitis, cystitis, and in chronic gonorrhoea or 
gleet. When taken in overdose it escapes from the body as hydro- 
chinone, making the urine dark-colored or black. 

Administration. — Arbutin itself is often used in the dose of 3 to 5 
grains. The dose of the flu id extract (Extr actum Uvce Ursi Fluidum, 
U S.) is 2 to 4 drachms three times a day. An infusion (Infusum 
Uvce Ursi) is official in the B. P., dose 1 to 2 ounces. 



VALERIAN. 

Valerian ( Valeriana, U S.) is the rhizome and rootlet of Valeriana 
Officinalis, a plant of Europe, but cultivated in America. It is 
official in the B. P. as Valeriana Rhizoma. Its active principle is 
apparently a volatile oil {Oleum Valerianae, U S.). It also contains 
valerianic acid. 

Physiological Action. — Valerian is a very feeble depressant to the 
nervous system, tending to produce nervous rest, but in cats it ex- 
cites sexual activity to a great degree, probably from its odor. When 
very large doses are given to man it causes a sense of warmth in the 
stomach, a slightly quickened pulse, and perhaps nausea and vomiting. 
Still larger amounts produce purging and mental hebetude. 

Therapeutics. — Valerian is used alone or in combination with other 
drugs to quiet nervous females and to relieve nervousness and insomnia. 
In hysteria it is often very serviceable, and combined with morphine 
is much used in the treatment of delirium tremens. 

Administration. — The fluid extract (Extractum Valerianae Fluidum, 
U S.), dose 1 fluidrachm, and the ammoniated tincture (Tinctura 
Valerianae Ammoniata, U S. and B. P.), dose 1 to 3 drachms, are 
the best preparations for ordinary use. The infusion, which is not 
official, is given in the dose of a wineglassful, while that of the 
simple tincture (Tinctura Valerianae, U S. and B. P.) is 1 to 3 
drachms. The dose of the oil (Oleum Valerianae, U. S.) is 2 to 4 
drops. An infusion (Infusum Valerianae) is official in the B. P., in 
the dose of 1 to 2 ounces. 



VERATRINA. 331 



VALERIANIC ACID. 

Aoidum Valerianicum is an oily, colorless liquid of a strong odor 
and burning taste, but is not employed in medicine except in the form 
of its salts, such as the valerianate of zinc, iron, quinine, or ammo- 
nium, all of which are employed partly for their sedative effects and 
partly for their influence as tonics. 

The dose of Zinci Valerianae is \ to 3 grains, that of Quinince 
Valerianas, U. 8., 1 to 3 grains, of Ferri Valerianas 2 to 10 grains, 
and of Ammonii Valerianas 2 to 10 grains. Under the name of " the 
pill of the three valerianates " Goodell recommends the following in 
nervousness and hysteria : 

Be . — Quininae valerianat. ^ 

Ferri valerianat j- . . . aa 9j- M. 

Ammon valerianat. J 
Ft. in pil. no. xx. S. — One or two three times a day. 



VERATRINA. 

Veratrina, U. S. and B. P., is an alkaloid derived from Veratrum 
Sabadilla, and occurs in a grayish powder, which, if it enters the nose, 
produces violent sneezing which lasts for hours. 

Physiological Action. Nervous System. — Veratrine has little 
effect on the cerebrum, but it does excite the spinal cord and the vol- 
untary muscles, thereby giving rise to tetanic or tonic convulsions, 
which are never clonic or epileptoid. The dominant action of the 
drug is paralytic and the nervous symptoms just named soon give 
place to paralysis. The muscles lose their contractile power and the 
nervous centres are depressed. 

Circulation. — In poisonous dose the heart is slowed by the drug, 
greatly weakened, and finally stopped in diastole, and is found after 
death to be soft and flabby. In smaller doses it at first slows the pulse 
by stimulating the peripheral inhibitory nerves and the centres in the 
medulla, but later these parts are paralyzed. It first stimulates the 
vasomotor centre, then paralyzes it. 

Eespiration. — The drug kills by failure of respiration due to 
paralysis of the respiratory centres. 

Temperature. — Veratrine always causes a fall of bodily heat. 

Poisoning". — The symptoms of poisoning in man are collapse, a 
pale, cold, wet skin, pinched features, and a rapid, thready pulse, 
accompanied by violent vomiting and muscular tremors. Tetanic 
convulsions may come on and resemble those of strychnine in that 
they arise from the slightest touch or draught of air • after death the 
muscles will be found to have lost their irritability. 

Therapeutics. — Veratrine is never used internally. It is employed 
chiefly in the form of an ointment rubbed into the skin over muscular 
rheumatism and rheumatic joints, and over neuralgic nerves. The 



332 DKUGS. 

official ointment (Unguentum Veratrince, U. S. and B. P.), or the 
oleate (Oleatum Veratrince, U. S.), should be used, the latter most 
carefully, as absorption of the drug may take place in sufficient 
quantity to poison the patient. 



VERATRUM VIRIDE. 

Veratrum Viride, TJ. S., Indian Poke, Poke-root, or Swamp 
Hellebore, is an American plant largely used for the purpose of 
allaying inflammation ; it is official in the B. P. under the name 
of Veratri Viridis JRhizoma. 

It probably contains a number of principles, the chief of which are, 
however, jervine and veratroidine. 

Veratrum viride is the safest and best circulatory depressant that 
we have for use in adults. 

Physiological Action. — The physiological action of this drug is to 
be considered under the effects of its two alkaloids before the complete 
effect is studied. 

Jervine. 

When Jervine is given in full toxic dose it causes great slowness of 
movement, relaxation of the muscles, through which thrills continu- 
ally run, and finally the animal falls to the ground. Violent epilepti- 
form convulsions may now ensue, but no tetanus is present. The 
convulsions soon give place to paralysis, and are characterized by 
their lack of force. Sensation is not affected until the near approach 
of death brings on anaesthesia. There is no evidence of gastro- 
enteritis and no vomiting or purging. The saliva is always increased 
and pours from the mouth. Death results by failure of the respiratory 
centres and an almost simultaneous failure of the heart. The heart 
and circulation are greatly depressed and the pulse-rate and force are 
far below their normal rate and strength. 

The blood pressure is very low except when the convulsion pro- 
duces a temporary rise, but the condition of the vagi is apparently 
normal. Jervine acts as a direct depressant to the vasomoter centres. 
The convulsions are due to the disturbance of the circulation at the base 
of the brain (Wood), and the spinal cord is directly depressed by the 
action of the jervine on its motor tracts. 

Veratroidine. 

This alkaloid is much more irritating than jervine, and in overdose 
causes vomiting and purging. The muscular twitchiugs and convul- 
sions caused by jervine are also produced by veratroidine, but are 
generally not so severe. It also depresses the spinal cord in its motor 
tracts. 

On the circulation veratroidine slows the pulse by stimulating the 



VERATRUM VIRIDE. 333 

pDeumogastric centres, but finally quickens it if given in very large 
closes, by paralyzing the peripheral vagi. 

The following summary given by Wood of the circulatory effect of 
veratrum viride, from a study of its alkaloids, is so brief and terse as 
to be worthy of insertion here : " Veratrum viride slows the pulse by 
a direct depressant action on the heart muscle (jervine), and by stimu- 
lating the pneumogastric nerves (veratroidine) ; it lowers blood pres- 
sure by an action on the heart muscle (jervine) and by depression of 
the vasomotor centre (jervine)." 

Poisoning. — Veratrum viride, while one of the most powerful 
drugs we have, is one of the least dangerous, since it almost invaria- 
bly causes vomiting before enough of the drug is absorbed to produce 
serious consequences. The vomiting is partly due to the veratroidine 
and partly to the presence of an irritant resin. In poisoning, cardiac 
stimulants, atropine, external heat, the placing of the head below the 
feet on an inclined plane, and the use of strychnine as a respiratory 
and nervous stimulant are to be resorted to. 

Therapeutics. — The chief use of veratrum viride is as a circulatory 
sedative in acute, sthenic, or dynamic inflammations. 

In pneumonia, pleurisy, acute hepatitis, peritonitis, and cerebritis it 
is of the greatest value if given at the proper stage when only con- 
gestion or hyperemia is present. After the onset of the lesions fol- 
lowing this period, its use is not only valueless, but malpractice. The 
only objection to the employment of veratrum viride in peritonitis 
lies in its tendency to produce vomiting, which is, of course, harmful 
when the peritoneum is inflamed. For this reason aconite is preferred 
to veratrum viride in peritonitis. Owing to its physiological influence 
veratrum viride bleeds a man into his own bloodvessels, and the indi- 
cations for its use are the same in inflammation as they would be for 
bleeding. In puerperal fever it has been highly recommended, but 
must be most carefully employed. It is also of value in excessive 
cardiac hypertrophy and in the irritable heart of strong healthy men. 
In aneurism where the circulatory disturbance is great and the arterial 
pressure high, the drug may be used, with great care, to decrease the 
pressure and prevent rupture of the diseased vessel. 

Contra-indications. — Veratrum viride is contra-indicated in all 
conditions of depression or exhaustion, and if vomiting is feared, 
must not be given in peritonitis or gastritis, as it may cause emesis 
and in this way disturb and irritate the abdominal contents. 

Administration. — The drug in inflammation should be given every 
half-hour or hour, and at least 1 drop of the tincture should be used 
each time in a healthy adult. In the course of two or three hours, 
or less, the skin becomes moist or relaxed, the pulse slower and less 
angry, and slight nausea may be present. These symptoms show 
that the drug is exerting its influence and it should now be withdrawn, 
or in very sthenic cases pushed a little farther. If vomiting comes on 
before the drug has acted on the circulation, 5 to 10 drops of lauda- 
num should be given 15 minutes before each dose of veratrum viride. 



334 DRUGS. 

The best preparation to employ is the tincture (Tinctura Veratri Viri- 
dis, U. 8. and B. P.), dose 1 to 3 drops. The fluid extract (Extractum 
Veratri Viridis Fluidum, U. S.) is given in the dose of 1 to 3 drops. 
Under the name of Norwood's Tincture, a saturated tincture has been 
sold. It is not official and ought never to be used. 



VIENNA PASTE. 

Potassa cum Calce, U. #., is a milder and more manageable escharotic 
than is caustic potash, and is used for the same purposes. (See Caustic 
Potash.) 

WARBURG'S TINCTURE. 

Warburg's Tincture is a complex liquid formed by the mixing 
together of no less than thirteen ingredients. Its inventor, Dr. War- 
burg, held its composition as a secret for a time, but finally made it 
public. Since he published the original formula it has been consider- 
ably altered, and some of the preparations now sold as Warburg's tinc- 
ture contain none of the original ingredients. Further than this, some 
of these ingredients are now not obtainable. It ought to be made as 
follows, if possible : 

Aqueous extract of aloes 28 grains. 

Ehubarb 448 " 

Angelica seed 448 " 

Elecampane 224 " 

Saffron ■ . . 224 " 

Fennel . . 224 " 

Gentian . 112 " 

Zedoaryroot 112 " 

Cubeb 112 " 

Myrrh . . 112 " 

White agaric . . . . ' . . ■> . 112 " 

Camphor 112 " 

Sulphate of quinine 1280 " 

Dilute alcohol enough to make 8 pints. 

The coarse vegetable portions of this list are to be ground into a 
coarse powder, and the myrrh and camphor, which have been pre- 
viously pulverized, added to them. The entire mass, less the quinine, 
is then digested for 12 hours in a well-covered vessel, on a water- 
bath, the alcohol being prevented from evaporating as much as pos- 
sible. The liquid is now to be strained under pressure and the sulphate 
of quinine added and dissolved. 

Therapeutics. — Warburg's tincture, next to pilocarpine, is the most 
powerful sweat-producer that we have, and possesses in addition very 
remarkable anti-malarial power. In this last respect it far exceeds 
quinine as a remedy in pernicious malarial regions for acute attacks 
and as a prophylactic. Its advantages over quinine rest in its favor- 
able action where congestions accompany the paroxysm. 



zinc. 335 

Administration. — To be of any value, Warburg's tincture should be 
given according to the following rules : The bowels of the patient 
should be first opened thoroughly by a saline purge, and a J ounce 
of the tincture should be given in one dose undiluted, no drink being 
taken. After the lapse of two or three hours a second \ ounce is given 
in the same way, and very shortly a profuse sweat appears, which gen- 
erally marks the crisis of the disease, and recovery soon takes place. 



ZINC. 

Zincum is not employed in medicine in its metallic form but in the 
form of several of its salts, of which there are a large number, each of 
which will be found under the names of the acids forming them. (See 
Sulphate of Zinc.) 

Physiological Action. — Nearly all the salts of zinc are somewhat 
astringent, and when taken internally act as depressants to the nervous 
system. Some of them are more irritating than others, such as the 
chloride and sulphate, whereas the valerianate has almost no power 
except so far as the valerian is concerned. 

All of the salts when taken for a long time in excess produce organic 
changes in the nervous system, generally represented by a myelitis, which 
differs from that caused by lead, which is ascending, while that of zinc 
is transverse. 

Zinc is eliminated by the liver and kidneys. Chronic poisoning 
among workers in zinc is rare, but has occurred. The symptoms 
closely resemble those of chronic lead-poisoning. 



PART III. 

REMEDIAL MEASURES OTHER THAN DRUGS. 
FOODS FOR THE SICK. 



ACUPUNCTURE. 

This is a term applied to the insertion of a small pointed instru- 
ment into the tissues of any part of the body for the purpose of re- 
lieving pain, swelling, or dropsies. When used in painful affections 
it accomplishes its best results in lumbago and sciatica, particularly in 
the former. When treating lumbago in this manner the writer takes 
two darning-needles, places them in boiling water to render them 
aseptic, inserts them one to one and a half inches and allows them to 
remain in place for several minutes. They are then slowly with- 
drawn, care being taken to prevent them from breaking off. Often 
after this treatment the patient can at once move more freely, to his 
great delight. Ringer has, with his usual clear clinical insight, noted 
that this treatment is more successful in those who have bilateral 
pain than in those cases who have one side affected, and the writer 
has found this statement invariably true. 

In sciatica acupuncture is less successful than it is in lumbago, but 
is always to be tried. The needle should be carried down until it 
reaches the nerve, and, perhaps, pierces its sheath ; and it must be 
absolutely aseptic. Bartholow has recommended the use of a hypo- 
dermic needle for the simultaneous injection of a few minims of 
chloroform or morphine. Sometimes the best results are reached 
from inserting the needle immediately below where the nerve finds 
exit from the pelvis. In other cases it is asserted that the insertion 
of a needle over a corresponding spot to that which is sore, on the 
sound side, may do good. Acupuncture is useless in acute rheumatism 
and for the lumbar pain produced by fevers. 

Sometimes a rhigolene spray may be used to freeze the skin over 
the parts with advantage in lumbago or sciatica 

Acupuncture is occasionally resorted to for the relief of dropsy, but 
it is not commonly employed, although it is often a useful measure. 
When the skin of the limbs becomes so tense with an effusion as to 
endanger its life, the tension should be removed by incisions, not 
punctures ; but saline purges are better for the removal of dropsy, if 
they can be used. Punctures rapidly close and make hard spots, 

22 



338 REMEDIAL MEASURES OTHER THAN" DRUGS. 

while incisions remain open and permit free drainage. Immediately 
after the incisions are made the parts are to be dressed with cotton 
previously saturated with boric acid solution and dried, or by ab- 
sorbent cotton sterilized by baking it in an oven. It is hardly necessary 
to point out that the incision must be made under antiseptic precau- 
tions. (See Antiseptics.) 



ANTISEPTICS. 

The term " Antiseptic/' as generally used, does not necessarily 
imply the power to destroy pathogenic germs. Any substance which 
inhibits the growth of microorganisms, which destroys or renders in- 
nocuous the poisonous products of their action upon the tissues of the 
body, or which retards or prevents the absorption of such products, is 
properly termed antiseptic. Since germicides necessarily possess anti- 
septic attributes, they should, strictly speaking, be classed with anti- 
septics ; in this portion of the work, however, only such drugs as are 
sufficiently innocuous to allow of their use in the human body or upon 
its surface will be considered. Some of these, as, for instance, carbolic 
acid and bichloride of mercury, are efficacious solely from their germi- 
cidal properties. Others, and of this class iodoform is the most im- 
portant and typical example, exert their influence, not upon the micro- 
organisms, but upon the toxic substances formed by these organisms. 

Of the long list of antiseptics which have within recent years re- 
ceived warm commendation at the hands of individual writers, there 
are comparatively few which have retained the confidence of the pro- 
fession after prolonged trial. Only these few well-proven drugs will 
be discussed in this article. 

Heading the list, and in its germicidal power far surpassing all 
others, is Bichloride of Mercury. Long since, the researches of Koch 
have shown that this salt is efficacious as a germicide in a watery solu- 
tion of 1 to 50,000. He stated, however, that where albumin was 
present the bichloride was decomposed and rendered inert. The same 
change was observed when solutions were allowed to stand for some 
length of time, even when distilled water was used as a solvent. By 
the addition of either sodium chloride or a weak acid such decomposi- 
tion was prevented. 

From this it follows that under ordinary circumstances solutions 
of bichloride should be freshly prepared, or, if it is desirable to keep 
them for a long time, a sufficient amount of sodium chloride should be 
added to prevent precipitation of the mercury salt. Koch advised 
that as much salt should be added as would equal the weight of the 
sublimate. Other observers, however, have advised ten times this 
weight of sodium chloride. 

Since whenever bichloride solutions are used in wounds or in cavities 
of the body they are brought in contact with blood-serum or other 
albumin-bearing substances, care must be taken that the antiseptic 
powers of the mercury lotion are not destroyed by the decomposition 



ANTISEPTICS. 339 

of its active principle. The power of the solution may be preserved 
by using it in such large excess that the small amount of chemical 
change has practically no effect, or by combining with it, as stated 
above, an acid which will not in itself be unduly irritating to raw 
surfaces. This end is accomplished by tartaric acid. In making up 
a solution, one part of bichloride and five parts of tartaric acid are 
added to as much water as is needed. Thus, in making up a solution 
of 1 to 1000, for surgical purposes, the following prescription maybe 
employed : 

R . — Hydrarg. chlorid. corros gr. xv. 

Acid, tartaric . . . . gr. xv. vel gj. 

Aquse dest. Oij. M. 

Bichloride solutions are used in the strengths of 1 to 500, 1 to 1000, 
and 1 to 2000, in the treatment of ordinary wounds. For the irriga- 
tion of large cavities solutions of a strength greater than 1 to 10,000 
should rarely be employed, and even these dilute lotions have, when 
used in the peritoneal cavity, given rise to toxic symptoms. The 1 to 
2000 solution is the one generally employed for sterilizing wounds and 
irrigating during operations. The stronger solutions of 1 to 500 or 1 
to 1000 are used in cleaning the surface of the body. 

The ordinary method of preparing a surface of the body for opera- 
tion is as follows : The part is first thoroughly scrubbed with soap and 
warm water, is shaved, and is washed again as before. It is then 
cleansed with alcohol or ether, after which a scrubbing with bichloride 
solution of 1 to 500 should follow, and be continued for at least two 
minutes. If no surgical interference is immediately indicated, the 
whole operative region should be enveloped in towels wrung out in a 
solution of 1 to 500 or 1 to 1000, and kept thus protected until the 
surgeon is prepared to operate. The moment the skin is incised no 
lotion stronger than 1 to 2000 should be employed, or if the more 
powerful solutions are used they should immediately be flushed out 
with one of less strength. The dressings, unless some particular form 
is used, may consist of boiled, bleached, and sun-dried gauze, soaked 
in a 1 to 500 bichloride solution and subsequently washed and wrung 
out in a 1 to 3000 dilution of the same antiseptic. 

Next in order of importance and in efficacy among the antiseptic 
preparations is Carbolic Acid and its solutions. The particular value 
of this drug lies in the fact that its potency is equally developed in 
both albuminous and non-albuminous solutions. Like the mercury 
salts, its great disadvantage lies in its toxic properties. It is usually 
used in solutions of 1 to 20 and 1 to 40. The carbolic acid of com- 
merce is found in a liquid form, dissolved in alcohol, and represents a 
strength of about 95 per cent.. In making the solution for surgical 
purposes, an ounce of this liquid is added to 20 or 40 ounces of water, 
according to the strength of the solution desired. Although carbolic 
acid is soluble in fifteen parts of water, this solution does not take 
place immediately, and in making solutions of a strength of 1 to 20 
either the water must be hot or a certain amount of time and consid- 



340 REMEDIAL MEASURES OTHER THAN DRUGS. 

erable agitation of the mixture are required, otherwise globules of 
almost pure carbolic acid are deposited in the bottom of the tray or 
vessel into which the solution is poured, and these, by coming in con- 
tact with instruments or with the hands of the operator, exert an 
undesirable cauterant effect. 

The 1 to 20 solution is used for the disinfection of instruments and 
the cleansing of surfaces. For half an hour before an operation it is 
customary to submerge all instruments which will be required in a 
solution of this strength, and when the surgeon is ready to use these in- 
struments the solution is diluted to 1 to 40 by the addition of an equal 
volume of water which has been boiled. If a carbolic lotion is em- 
ployed for irrigation, or for cleansing sponges during an operation, it 
should not be stronger than 1 to 40. 

A property possessed by carbolic acid, which renders it an unsafe 
medium for the impregnation of gauze, is its volatility. After an ex- 
posure of a few hours to the atmosphere it entirely evaporates, leaving 
not an antiseptic, but simply a sterile, dressing. This fact is utilized 
by the surgeon in the preparation of the deeper layers of the dressing, 
which come in immediate contact with the lips of the wound. Since 
all antiseptics are more or less irritatiug to raw surfaces, healing will 
be promoted by a sterile rather than by an antiseptic application. By 
moistening a piece of boiled and sun-dried gauze, sufficiently large to 
cover the wound-edges, in a carbolic solution of 1 to 20 the antisepticity 
of this dressing is assured, and in a very few hours the heat of the body 
causes the entire evaporation of all the carbolic acid, leaving a sterile, 
non-irritating surface in contact with the wound. If protective is 
used, or oiled silk is applied beneath the dressing, these materials 
should be treated with carbolic acid in the same way. 

In addition to its toxic effect upon the patient, carbolic acid greatly 
irritates the hands of the surgeon, and if used in a strength of more 
than 1 to 40 causes so much benumbing of tactile sensibility that 
manipulative skill is seriously interfered with. The cracked and fis- 
sured fingers resulting from the use of carbolic lotions are familiar to 
all, and at times produce results of far more serious import than tem- 
porary pain and discomfort ; many recesses are provided in the depths of 
which septic germs may successfully resist the action of antiseptic washes. 
There can be no question that septic poisoning has been frequently due 
to this fact. 

Iodoform occupies a unique place among antiseptics in having been 
almost universally accepted and used by surgeons and clinicians in 
spite of the fact that its germicidal action has been well proved by 
laboratory research to be practically nil. It is found that nearly all 
forms of pathogenic germs grow abundantly upon culture materials, 
the greater part of which is made up of iodoform, and that injections 
of such germs, mingled with large quantities of iodoform, produce 
the characteristic eifect upon living tissues with almost as great cer- 
tainty as though this drug had not been used ; furthermore, it has 
been shown that iodoform is not even sterile, and that as employed 



ANTISEPTICS. 341 

by surgeons it was frequently a cause of infecting previously aseptic 
wounds. 

In spite of this overwhelming evidence against it, the drug steadily 
grows in favor. Recent researches have explained, in part at least, 
the reason for this contradiction between experimental and practical 
results. It has been well said that the human body is not a test-tube, 
and that bacteriological research cannot supplant the evidence of 
clinical observation. Elaborate investigation showed that this drug 
acted as a powerful antiseptic, not by destroying the germs, but by 
undergoing a decomposition in their presence, the products of which 
render the ptomaines, the result of germ growth, inert. In this way 
suppuration is, to a certain extent, inhibited, or, if present, its disas- 
trous effects upon the system at large are prevented, since these are 
due to ptomaine absorption rather than to a direct effect of the micro- 
organisms themselves. It has been apparently proved that ptomaines, 
in themselves and without the presence of microorganisms, can gene- 
rate pus, but that where such ptomaines are mixed with iodoform 
before infection no pus is formed. If these septic chemical compounds 
are rendered inert, a powerful adjuvant to the destructive action of 
the germ upon living cells is removed, and thus the system is often 
enabled to overcome one enemy where two would have prevailed. The 
fact that iodoform is in itself not sterile is, from a practical stand- 
point, most important. Fortunately, sterilization is readily accom- 
plished. A thorough washing in a 1 to 1000 bichloride solution 
destroys all microorganisms, and the powder may then be used with- 
out fear of producing infection. 

It will be readily understood from the foregoing that iodoform is 
of little service in aseptic wounds ; that it becomes of utility in direct 
proportion to the foulness of discharge, and that to exert its influence 
it must be applied directly to the part. It is liable, in suppurating 
wounds, to form a hard crust with the discharges, thus frustrating 
one of the most important indications in antiseptic surgery, i. e., 
drainage. Particular care should be exerted to see that the exudation 
from the surfaces of the wound has a free exit. 

As employed in surgery, iodoform, after having been sterilized, is 
placed in small pill-boxes or wide-mouthed jars, over the opening of 
which is tied a single layer of antiseptic gauze ; through this the iodo- 
form is sprinkled, as desired, over wound surfaces. 

Kreolin, or Creolin, a preparation obtained from English coal by 
dry distillation, has been steadily and rapidly growing in popular 
favor, and bids fair to rival carbolic acid. In addition to its powerful 
germicidal effect it is non-irritant and practically non-toxic. The 
claim first advanced that this preparation was absolutely non-poison- 
ous can no longer be supported, since cases have been reported where 
toxic symptoms have followed its use ; these were probably due to 
individual idiosyncrasy, a factor which we can never hope to entirely 
overcome. It is certainly true that kreolin is the least poisonous of 
all the powerful antiseptics heretofore used. As an additional advan- 
tage, in place of the harsh, irritating effect produced upon surfaces by 



342 REMEDIAL MEASURES OTHER THAN DRUGS. 

carbolic acid solutions, kreolin exerts an influence very like that of an 
oily or mucilaginous preparation. 

The extravagant claims advanced for kreolin in regard to its 
germicidal property have not been confirmed by bacteriological inves- 
tigation. In solutions containing albumin it is not efficient as a germi- 
cide in strengths of less than 1 to 100, its power being somewhat 
below that of carbolic acid; since, however, its toxic properties are 
much less marked than those of the latter drug, it can be safely used 
in stronger mixtures, and therefore, for practical purposes, its strength 
is greater. 

Kreolin, though insoluble in water, readily forms an emulsion quite 
as efficacious in its antiseptic properties as a true solution. Since this 
emulsion is opaque it is scarcely applicable for immersing and steril- 
izing instruments, the latter not being readily found. It is admirably 
suited, however, for cleansing the hands, a 5 per cent, solution neither 
cracking the skin nor benumbing the sensory nerves. In irrigating 
large wounds, cavities of the body, and particularly as a means of 
preventing sepsis or aborting it in gynaecological work, kreolin can be 
warmly commended. It may be employed in a strength of from 0.2 
to 5 per cent. 

Barring the opacity of its emulsion in water, it would be the medium 
'par excellence for rendering instruments sterile and maintaining them 
in this condition during an operation. 

Among the many antiseptic agents of less importance may be men- 
tioned Peroxide of Hydrogen. This drug comes in what is termed a 
fifteen -volume solution. By this it is meant that fifteen volumes of 
feebly combined oxygen are contained in each volume of the liquid. 
The few who have used it report remarkable results. It is applicable, 
not to sterile surfaces, but to suppurating wounds and sinuses. It is 
alleged that peroxide of hydrogen immediately destroys the micro- 
organisms of pus, converting, in one or two applications, a septic 
wound into one which is sterile and which will promptly heal. It is 
used in the strength of from 5 per cent, up to full concentration. Its 
disadvantages lie in the fact that it is expensive and that it readily 
undergoes decomposition. In this latter circumstance, possibly, lies 
the explanation of its want of popularity, since the preparations vary 
so greatly in strength that it is impossible to determine to what 
extent they should be diluted or what may be their potency when 
applied. (See Oxygen.) When this drug is poured into a suppurating 
sinus or cavity an ebullition takes place, which ceases only when the 
drug is exhausted or the infected surfaces are rendered sterile. With 
more extended trial the true value of this preparation will be deter- 
mined. 

Chloride of Zinc has been extensively employed in some clinics as 
an antiseptic application. It is used in 10 per cent, solutions, aud is 
applied when the field of operation is probably infected by pre- 
existing pus-formation. Although bacteriological research has shown 
that this agent possesses feeble antiseptic power, clinical experience 
demonstrates its great value when applied to infected surfaces. Lately 



ANTISEPTICS. 343 

the Sulpho-carbolate of Zinc has to a great extent replaced the chloride, 
as it is less toxic and irritating, and far more poteDt. 

For the sterilization of mncous surfaces a saturated aqueous solution 
of boric acid is commonly employed. 

Double Cyanide Dressing. 

The increasing popularity of the latest dressing prepared by Lister, 
and its possession of qualities apparently superior to those of any 
other dressing yet described, make it desirable to give a brief de- 
scription of the method of preparation described in Lister's latest 
writing on this subject. " Cyanide of potassium, cyanide of mercury, 
and sulphate of zinc are mixed together in solution, in quantities 
proportioned to the atomic weights of 2KCy, HgCy 2 , and ZnSo 4 
-f-7H 2 ; the cyanide of potassium and cyanide of mercury being 
dissolved together in 1J ounces of water for every 100 grains of 
potassium cyanide, and added to the sulphate of zinc dissolved in 
three times that amount of water. The precipitate is collected in a 
strainer, and when well drained is washed with two successive por- 
tions of water equal in quantity to that used for the solutions, namely, 
6 ounces for every 100 grains of potassium cyanide ; at least this 
amount of washing being essential in order to free the precipitate 
sufficiently from the highly irritating soluble salts which are associated 
with it in its formation. The precipitate having thus been washed 
and drained, but not dried, it is thoroughly diffused with pestle and 
mortar in distilled water (6 ounces for every 100 grains of potassium 
cyanide), containing in solution 1 part of hematoxylin for every 100 
parts of the cyanide salt, the amount of which is known from the 
circumstance that the dry product of cyanide salt is almost exactly 
equal in weight to the potassium cyanide employed. Hematoxylin 
is readily soluble in a small quantity of hot water, and remains in 
solution when added to a large quantity of cold water. The cyanide 
salt, while it precipitates the hematoxylin, changes its color to a pale 
bluish tint. This is advantageously enhanced by the addition of a 
little ammonia to the mixture, in the proportion of one atom of am- 
monia (NH 3 =17) to each atom of hematoxylin (C 16 H 14 6 3H 2 
= 356). More than this amount proves prejudicial. The ammonia 
is added in a dilute form, and it is convenient to have the dilution 
such that 1 fluidrachm of the ammoniacal liquid shall correspond 
with 1 grain of hematoxylin. The dye is further economized by 
allowing the ammoniated mixture to stand for three or four hours, 
and stirring it occasionally, so that the ingredients may react thor- 
oughly upon each other. If the mixture is filtered immediately, there 
is considerable loss of coloring matter. The dyed salt, having been 
drained and dried at a moderate heat, is levigated, and may then be 
kept for any length of time fit for use. When employed for charg- 
ing a dressing it is diffused by means of pestle and mortar in solution 
of bichloride of mercury (1 to 4000) in sufficient abundance to drench 
the fabric thoroughly, for which 4 imperial pints to 100 grains of the 



344 REMEDIAL MEASURES OTHER THAN DRUGS. 

salt will be found adequate. This will give a percentage of between 
2 and 3 of the cyanide to the dry gauze. The gauze should always 
be used moist ; aud if it be prepared for immediate use, as by the 
dispenser of a hospital, the process of drying may be omitted, and the 
gauze, after being hung up for a while to drain, is further deprived of 
superfluous moisture by placing it for a while in a folded sheet. It 
may afterward be conveniently kept moist by wrapping it in a piece 
of mackintosh cloth. When obtained dry from the manufacturer, it 
should be moistened again with a weak corrosive sublimate solution 
before it is used." 

The advantages claimed for this dressing are that it is not irritating 
to the skin, and that the antiseptic substance is not soluble, hence is 
not washed out by discharges. 

An omission of the details of cleansing the hands of the surgeon 
and assistants in preparing for an antiseptic operation is scarcely 
permissible in writing upon the subject of antisepsis. The most 
approved method is as follows : 

The hands and forearms are thoroughly brushed in hot soap-suds 
for several minutes, after which the nails are carefully cleaned by a 
knife and brush, and the washing again repeated ; the hands are then 
washed in alcohol for one minute, special attention being paid to the 
nails ; finally they are soaked for three minutes in a solution of bi- 
chloride (1 to 1000), and during the course of the operation are occa- 
sionally washed in a solution of the same strength. If it is neces- 
sary to lift a chair, to turn the patient, or to touch any object which 
has not been previously sterilized, the hands should be enveloped in 
towels wrung out in 1 to 1000 solution, or immediately washed again. 



COLD AS A REMEDY. 

Cold, or the rapid abstraction of heat, is a remedial measure that 
can nearly always be obtained and is possessed of very great power for 
good in properly selected cases. At the very first, we may divide its 
use into its local application, for a superficial, limited, deep-seated, or 
distant influence, and its general application for the purpose of affect- 
ing the entire body. 

When cold is applied for its limited and local action, it is always used 
with two objects in view, namely, to cause localized contraction of blood- 
vessels, which, through inflammation, are engorged so that the parts 
are reddened and swollen, or temporarily to anaesthetize or benumb a 
nerve-fibre for the immediate relief of pain and with the hope that the 
temporary paralysis may ultimately result in such nerve changes as to 
produce a cure. 

For these reasons cold, in some form, is a popular remedy for a 
burn or sprain, or any injury likely to be followed by inflammatory 
processes. In some cases, it is true, hot water or dry heat is equally 
efficacious, and this fact will be referred to again when speaking of 



COLD AS A REMEDY. 345 

heat. (See Heat.) It may, however, be stated, as an almost invariable 
rule, that the choice of heat or cold is to be governed by the sensations 
of the patient, who will generally assert that one of the two is the 
more agreeable. 

Cold or heat cause relief of pain in inflammation by producing con- 
traction of the local bloodvessel walls. As a result, inflammatory 
exudates do not occur, congestion is relieved, and as the pressure on 
the nerve filaments ceases, the pulsating pain of inflammation passes 
away. 

A very useful remedy for the sprain of an ankle, when it is a recent 
accident, is to let the patient sit with the foot elevated, with a cloth 
wrung out in ice- water, or an ice-bag applied over the part affected. 

In the treatment of localized pain, cold is used in a number of 
ways, largely depending in their choice on the will of the physician 
and the wealth of the patient. The simplest, cheapest, and perhaps 
the most efficient method of using cold is to place cracked ice in a 
pig's or sheep's bladder, and after tying the opening to prevent leak- 
age, to lay it directly on the skin, surrounding it with a towel so as to 
prevent the moisture which appears on the surface, from condensation, 
from wetting the clothing. 

Where a very limited and comparatively transient effect is needed, 
it is customary in hospital and private practice to use a piece of ice 
sprinkled with a little fine salt, and held against the skin by means 
of a towel in the hands of a physician. Actual freezing can often be 
produced in this manner very rapidly. 

"Where a more rapid and elegant method is desired, sprays of various 
very volatile liquids may be driven against the part by an atomizer. 
Probably the most readily employed of these liquids is ether, which 
is fairly effective if it is used in a fine spray and driven against the 
skin in such a way as to favor rapid evaporation. Another of these 
agents is rhigolene, which is one of the lightest and most volatile of 
the liquid products of coal-tar, and is used in a spray from an atomizer 
in the same manner as is ether. Chloride of methyl is a gas, which is 
very inflammable, of a sweetish smell and taste, used as a substitute 
for rhigolene as a local anaesthetic through the intense cold produced 
by its application. The gas is to be directed against the skin over the 
involved area by means of a tap attached to the cylinder containing it. 

It is hardly necessary for the writer to repeat that, as the last 
three applications are very inflammable, they should not be used near 
a light or fire. 

Aside from the local effects of cold on inflammatory processes, it is 
largely resorted to for the relief of neuralgia of a superficial type, and 
has often been used for the cure of deep-seated neuralgias, as over the 
course of the sciatic nerve in sciatica. Generally, however, it is em- 
ployed in neuralgia of the supra-orbital nerve, where, owing to the 
superficial position of these fibres, the cold can readily penetrate. 
The skin should be distinctly whitened and blanched, and even hard- 
ened, by the cold before its application is stopped, and if one applica- 
tion does not cause a cure it may be repeated every day for several 



346 REMEDIAL MEASURES OTHER THAN DRUGS. 

weeks in obstinate cases. Sometimes cold is used to benumb the skin 
or subcutaneous tissues in cases where a minor surgical operation is to 
be performed, and it is undoubtedly superior to cocaine where one 
wishes to open boils or small abscesses. It is also valuable when the 
physician is using the actual cautery, and in all these cases may be 
employed as is indicated above. 

The local employment of cold for the influencing of deeply-seated 
organs is not only a well-recognized therapeutic measure, but of great 
practical and physiological interest, and is so closely associated with 
the subject of counter-irritation as to be worthy of comparison by the 
reader with the article on that subject before considering the subject 
as sufficiently studied to render its use clear. According to Winter- 
nitz, cold applied to the feet affects the cerebral circulation, cold to the 
thighs the circulation in the lungs, and cold to the back the circula- 
tion around about the pituitary region. That these assertions are true 
we do not positively know, but the fact that Winteruitz has reached 
them by a series of experimental studies indicates their correctness to 
a great extent, and they also find additional support in the popular 
and medical confidence in the use of cold to the head and heat to the 
feet in cerebral diseases. 

Practically cold has been employed with no small degree of success 
in the treatment of pneumonia and pleurisy in the form of the ice- 
poultice or ice-jacket. The only thing needful for such treatment is 
a condition of strength on the part of the patient, for it should not 
be used in adynamic cases. When the ice-poultice is used it is made 
by taking a mass of finely-chopped ice, draining it of all water, and 
mixing it thoroughly with dry sawdust, in sufficient quantity to 
absorb all the water derived from the ice as it melts. This is then 
basted into a quilt, so arranged that all of the contents will not sag 
to the lower border, and wrapped around the chest, the mass being 
thoroughly covered by a layer of well-oiled silk. Cold has also been 
highly recommended when used in pneumonia in another manner, and 
by no less prominent an authority than Niemeyer, who speaks of it 
as follows : 

" I have made extensive employment of cold in the treatment of 
pneumonia, and relying upon a large number of very favorable 
results, can recommend this procedure. In all cases I cover the chest 
of the patient, and the affected side in particular, with cloths which 
have been dipped in cold water and wrung out. The compresses 
must be reapplied every five minutes. Unpleasant as this procedure 
is in almost all cases, yet even after a few hours the patients assure 
me that they feel a material relief. The pain, the dyspnoea, and often 
the frequency of the pulse are reduced. Sometimes the temperature 
goes down an entire degree. My patients often retain this surprising 
condition of improvement throughout the entire duration of the 
attack, so that their outward symptoms would hardly lead one to 
imagine the grave internal disorder. The relatives of the patient, 
too, who do not fail to perceive the improvement, now readily assist 
in the treatment to which at first they were opposed. In a few cases, 



COLD AS A REMEDY, 347 

and only in a few, the use of cold affords no relief, and the trouble- 
some manipulation for its application increases the distress of the 
sufferers so much that they refuse to keep it up. In such cases I 
have not insisted upon the further application of cold. 

" In the hospital at Prague every case of pneumonia is treated with 
cold compresses, and, according to the statements of Smoler, it is ex- 
ceptional for a patient not to feel material relief from this treatment. 
I should only ascribe a palliative influence to their use, had not the 
duration of the disease in many instances been decidedly shortened 
and the convalescence hastened by means of their energetic and 
methodical employment. In fact, in but few cases have we seen the 
disease delay its departure until the seventh day. Many have im- 
proved on the fifth, and a very large number as early as the third 
day ; nay, I have repeatedly found it impossible to keep patients 
with recent pneumonia in the hospital for a longer period than a 
week. Cold is rightly regarded as one of the most efficient anti- 
phlogistics in inflammation of external organs. Its action is directly 
tonic upon the relaxed tissues and dilated capillaries." 

The use of a cold bath, for the purpose of increasing the tone of the 
system, is as old a custom as any which we have, but, like all other 
things in medicine, cannot be used without distinct indications for its 
employment, or to speak more correctly, the absence of certain contra- 
indications. The most universal exception to its use which we find 
is that class of persons with whom bathing of any kind, particularly 
when it is frequently repeated, does not agree. The writer is sure 
that a much larger number of persons belong to this class than is 
generally recognized, and he has seen cases of nervous exhaustion and 
general loss of vivacity and vitality occur as a result of too frequent 
bathing. This is the case more especially with daily bathers who 
use cold or warm fresh water, particularly if the bath be taken in 
the morning. 

Before passing on to a consideration of the physiological action of 
a bath, and why and when we should use it, it is proper to call atten- 
tion to the fact that a very large proportion of children who are 
bathed daily are allowed to lie and soak in the tub, and as a result 
become debilitated and fretful, only to recover when the bath is used 
once or twice a week, and replaced in the interval by a nightly spong- 
ing off w r ith salt and whiskey or salt and water. 

Through practical experience and much experimental research of 
a more or less reliable character, we now know that the following 
phenomena accompany the use of a cold bath in a healthy person 
with whom such a bath agrees. 

On entering the water he shivers, thinks it almost unbearably cold, 
his teeth chatter, and he gasps if the cold suddenly touches the belly 
wall, or an equally sensitive surface. In a moment, however, reaction 
sets in, and the extremities heretofore blue, trembling, and covered 
with cutis anserina, become warmer and flushed. The pulse is in- 
creased in force and frequency, and the respirations are deeper and 
more thoroughly performed. As a result of this, each portion of the 



348 EEMEDIAL MEASURES OTHER THAN DRUGS. 

body receives a more perfect supply of blood and feels rejuvenated. 
Following this stage of exhilaration a third comes on in which the 
blueuess and depression of the first stage recur in an exaggerated 
degree, but this condition does not ensue unless the person remains 
too long in the water. If he leaves the bath while in the acme of his 
exhilaration, the stimulus may remain with him throughout the rest 
of the day. 

The reason for the occurrence of this train of symptoms is not far 
to seek. The chilliness of the first stage shows that the great abstrac- 
tion of heat is lowering the bodily temperature, the centres for calori- 
fication in the body not manufacturing all the heat that is needed for 
the preservation of the normal temperature. At first the cold drives 
the blood hurrying into the warm recesses of the body, leaving the 
surface of the body cold ; but in a few moments the system is aroused 
to the recognition of the fact that it must increase its exertions in the 
propulsion of blood and manufacture of heat, and so with an effort it 
puts forth all its power, picks up each corpuscle that is hiding from 
the cold in the internal organs, and, after imbuing it with warmth 
obtained by increased heat-production in the sources of heat-manu- 
facture, forces it out to the surface of the body along with its fellows, 
which are driven to all parts of the system. This is not a mere 
figurative way of putting the matter, for cold always contracts 
bloodvessels and reflexly stimulates the vital centres to increased 
activity. 

When the bath is too prolonged the result of over-stimulation 
ensues, and the depression of the nervous system and circulation 
may be sufficiently severe to interfere greatly with normal functional 
activity. 

Just at this point it becomes clear w T hy persons " catch cold," or, 
more technically speaking, are attacked by local or general conges- 
tions. One person who is weak may never reach the stage of stimu- 
lation of which we have just been speaking, because his system has 
not enough units of force in it to unite them and expend them upon 
the functional activities named, and, as a consequence, the blood, 
which at the first shock has hurried into the internal viscera, is not 
driven back to its duty, but sulking in its retreat, like a deserting 
soldier, allows disaster and disease to ensue because its superior officer, 
the central nervous system, cannot gather together enough force or 
authority to make it do its duty. These cases present evidences, there- 
fore, of circulatory and systemic depression, or have congestion of the 
lungs, liver, or other parts. In the strong person exactly the same 
state of affairs obtains in the third stage of depression, but only after 
the streugth of the system has been expended in the activity of the 
stage of exhilaration. 

Cold salt baths, particularly if they are sea baths, are more stimu- 
lating and not so relaxing as is fresh- water bathing. 

Cold effusions to the head, or, better still, the use of an ice-bag, 
have long held a high position in the treatment of meningitis and head 
injuries, and a hot bottle to the feet and cold to the head will often 



COLD AS A EEMEDY. 349 

cause sleep in persons who habitually suffer from insomnia. This is 
particularly the case with those persons who have wakefuluess from 
mental over-work. Ou the other hand, cases with insomnia from 
cerebral anaBinia do well if a cold pluuge bath is taken before going 
to bed, although iu still other cases a hot bath is more efficacious. (See 
Heat ) The latter iustauces are not due to ansemia but to nervous 
irritability, which the heat quiets, whereas the insomnia of cerebral 
anseniia is relieved by a cold plunge by reason of the increased circu- 
latory activity produced by the bath. 

When cold is to be applied to the head continuously it is often con- 
venient to employ a coil made of rubber tubing, and so shaped as to 
fit the vertex. One end of the tubing should reach to a tub of cold 
water on one side of the bed and the other to an empty tub on the 
other side. By sucking on one tube sipkonage is established, and as 
soon as the liquid has been transferred from one tub the stream may 
be reversed and the water passed back again to its former receptacle. 

The use of a cold bath after a person becomes heated is popularly 
supposed to be dangerous. On the contrary, every athlete knows that 
nothing is so refreshing and so preventive of muscular stiffness after 
severe exercise and sweating as a cold plunge or shower bath, but he 
also recognizes the fact that a plunge is all that is permissible, and it 
is only the person who possesses the healthy circulatory power which 
will enable him to rebound from momentary depression to increased 
activity that should resort to such procedures. 

Cold water dashed or sopped against the perineum or the scrotum 
and the lumbar region, is a favorable remedy for nocturnal seminal 
emissions with some practitioners, and the scrotum may be submerged 
in a tumbler of cold water for a few minutes at night for a similar 
purpose. 

A very useful treatment of dysentery is to gently inject into the 
rectum about one or two quarts of cold water — if necessary it may be 
icy cold ; and a similar application for piles is a useful adjunct to all 
forms of treatment for these troublesome formations. 

So highly do some physicians praise this method, that the writer 
has thought it proper to quote from a paper of Dr. J. William White 
upon this subject. He says : 

" I desire to call the attention of the profession to a method of 
treatment which, although not altogether new, is yet not appreciated 
as, in my judgment, it should be. I refer to a moderately forcible 
stream of water of varying temperature in the treatment of a number 
of affections of the rectum, anus, and genito-urinary apparatus. The 
tonic and astringent effect of such a stream of water upon any living 
tissue is, of course, a well-understood fact, and has been employed in 
the arrest of h&emorrhage, in the treatment ot inflammation, and in 
various conditions. But it has only been in exceptional cases, and 
usually by the aid of more or less troublesome apparatus that it has 
been used in the class of cases to which I now refer. 

" The bidet, as I have now for a few years prescribed it, should be 
of the variety which can be attached to the water-closet seat habit u- 



350 REMEDIAL MEASURES OTHER THAN DRUGS. 

ally used by the patient. It should have a nozzle capable of throw- 
ing a stream of about the calibre of an ordinary lead-pencil, or a little 
less. The head of water should be sufficient to make it impinge 
upon the parts exposed to it with enough force to excite there a little 
sensation of smarting or tingling. That degree of force will, for ex- 
ample, be sufficient to enable the patient to take an enema, or, if a 
female, to take a vaginal injection. The bidet pipe should be movable 
by means of a handle, so that the stream can be directed against any 
portion of the external genitals, the perineum, the anus, or the sur- 
rounding parts. It should also have connection with the hot and 
cold water supply of the house, so that the water may be used of any 
temperature which the physician may prescribe, or which the sensa- 
tions of the patient may make desirable. Stop-cocks should regulate 
the size and force of the stream, and should be so placed as to be 
easily reached by the hand of the individual sitting upon the water- 
closet seat. Such an apparatus can be put in place by any experienced 
plumber, in any ordinary water-closet, at an expense of from fifteen 
to twenty dollars ; and, in Philadelphia at least, the usual head of 
water obtainable even in third-story rooms is quite sufficient for all 
therapeutic purposes. 

"The cases in which it may be desirable to use this method of 
treatment may be divided into two classes : First, those affecting the 
lower end of the bowel and its outlet ; second, those involving the 
genito-urinary system. Among the first the most important are 
haemorrhoids, internal and external, prolapsus ani, and slight cases of 
prolapsus recti ; pruritus ani and eczema of the margin of the anus 
should also be included in this group of cases, in which it has now for 
some time been my habit to prescribe the systematic employment, 
twice daily, of the bidet, once immediately after the daily stool, and 
for the second time, by preference, just before going to bed. As a rule, 
in all the mid-winter months, the ordinary temperature of the Schuyl- 
kill water is that to be preferred, although I am largely governed by 
the feelings of the patient in this respect. An enema should be taken 
at each of these times, the lower portion of the rectum being thus 
thoroughly washed out at least twice daily, after which the stream of 
water is allowed to play upon the affected region for a period of from 
five to fifteen minutes. The ordinary and useful effect of cool spon- 
ging or washing immediately after stool in cases of haemorrhoids is by 
this means enormously increased. Internal haemorrhoids will, under 
this treatment, in many cases almost entirely disappear, unless they 
are exceedingly large and have been frequently inflamed or strangu- 
lated and badly neglected ; external haemorrhoids, even when fleshy, 
will shrivel and become scarcely noticeable. 

" I could detail a number of cases of this character taken from my 
practice of the last two years. In some instances in which I had been 
habitually called in, at intervals of a few months, in the case of old 
people, the result has been practically their disappearance from my list 
of patients ; and they speak in the warmest manner of the great com- 
fort derived from this simple method of treatment. 



COLD AS A REMEDY. 351 

" Perhaps nothing is more distressing among minor affections than 
the trouble described as pruritus ani, and variously attributed to liver 
disease, constipation, gastric troubles, latent gout, uterine disease, para- 
sites, neuroses, and a number of other causes, varying from eating of 
shell-fish, or excessive smoking, to alleged hereditary predisposition. 
There are very few practitioners of any experience who have not dis- 
covered how difficult it is in any particular case of pruritus to assign 
distinctly the annoying symptoms to any one of these causes. Often 
the whole list may be carefully gone through and eliminated, or the 
proper remedies may be applied successively, as different theories are 
adopted, without the slightest benefit resulting. Ointments, lotions, 
and ordinary cool bathing will be tried in great variety, but without 
avail ; and such patients will often go from one physician to another, 
or fall into the hands of quacks while seeking proper professional re- 
lief. My list of cases of this character, which I have now treated by 
means of the ' bidet/ comprises eight. 

" Nearly all my cases have resulted in cure ; requiring, to attain 
that end, simply different lengths of time of the application of the 
douche, with variations of the temperature of the water, and occasion- 
ally the use of some emollient salve. I have been particularly struck 
by the fact that these cases include among their supposed causes 
widely distinct conditions, and the uniformity with which they have 
yielded to this simple treatment has led me to regard with suspicion 
the orthodox etiology of the disease. In procidentia ani, and in slight 
cases of prolapsus recti, I have had very satisfactory, though, of course, 
less striking results. In a few instances the trouble almost entirely 
disappeared, and in all of them it was distinctly relieved. These cases 
require for their successful treatment a much longer application of the 
douche, and the water should, in my judgment, be at one or the other 
extreme of temperature — either quite cool, or as hot as can be comfort- 
ably borne. 

" I am quite aware that the use of cold water in these affections is 
not in the least a novel plan of treatment ; but the method under con- 
sideration combines the effects of temperature with a sufficient force of 
the stream, and admits of the prolonged application of the remedy 
without effort on the part of the patient, who is in the most suitable 
position for this treatment — practical points which induced me to make 
this mention of my results in rectal and anal cases. 

" Agnew says of pruritus, that among the local remedies frequent 
ablutions with cold water should be mentioned ; and of prolapsus ani 
et recti, that ' In all cases where remedies have proved unavailing, or 
where patients have declined an operation, much good may be done by 
douching the parts with cold water and applying an oiled compress ;' 
and Allingham says of the same class of cases, that i The frequent and 
bountiful application of cold water is to be most strongly recommended ;' 
but few authors, so far as I know, have especially alluded to the method 
of application by means of a bidet. 

" My second class of cases includes, chiefly, certaiu prostatic troubles, 
varicocele, atonic impotence in the male, aud pruritus of the vulva or 



352 REMEDIAL MEASURES OTHER THAN DRUGS. 

vaginitis in the female. In case of variocele, although I have not 
succeeded in effecting a cure in any instance by this method, I have 
certainly seen advancing enlargements of the spermatic veins be- 
coming stationary ; long relaxed and pendulous scrotums become firm 
and much smaller ; and the mental condition of the patient, which is 
so important an element in many of these cases, shares in the improve- 
ment. In chronic prostatitis, a most intractable and distressing ail- 
ment in many instances, it has come to be a part of my routine 
treatment to order the use of cold perineal douches by means of the 
bidet, associated with frequent cool enemata given in the same man- 
ner ; and I believe to-day that if I had to discard all therapeutic 
measures but one in these cases, I would retain this one. In a cer- 
tain number of cases of impotence, associated with general muscular 
weakness, loss of tone, lack of general strength and vitality, accom- 
panied by imperfect or rapidly subsiding erections, I have found 
that the cold douche applied with some force and for considerable 
lengths of time to the perineum and testicles has been productive of 
marked benefit. 

" In two cases of pruritus vulvae my results have been good, 
though less striking than in similar disease affecting the region of 
the anus. In vaginitis, where the woman has sufficient intelligence 
to learn how to take an injection by means of the bidet, it offers an 
admirable method of cleansing the vagina, of carrying away thor- 
oughly all accumulated secretions, of reducing heat and swelling, 
and at the same time of avoiding the frequent introduction into the 
inflamed canal of a foreign body in the shape of the nozzle of a 
syringe. My opportunities for observation in this class of cases have 
been limited, owing to the disinclination of these patients to procure 
the bidet, and owing to their irregular habits of life and their frequent 
changes of residence ; but I have seen enough of its good results to 
make me feel confident that it is valuable addition to our therapeutic 
agencies. 

" After all, in every one of the cases which I have mentioned, its 
use is simply the application of the most elementary and common- 
sense principles to every-day practice, but I am satisfied that this 
particular method of applying these principles has not received the 
attention which it merits." 

Cold in Fevers. 

The proper manner to employ cold water in fever should be thor- 
oughly understood. It may be used at a number of temperatures, 
according to the effect desired, such as cool, moderately cold, and very 
cold. 

Very commonly in the course of a fever the patient is restless, un- 
comfortable, and sleepless, yet has not a temperature fraught with any 
harm. Such a case may be sponged off with tepid water or with a 
little alcohol and water, or salt and whiskey, with great benefit in the 
production of sleep, the reduction of fever, and the advantage of ner- 



COLD AS A REMEDY. 353 

vous quiet. Sometimes the sponging is successful when used only 
over the arms and legs, but more frequently it should be extended at 
least to the spinal column. 

If tepid sponging does not lower the fever in a given case, then 
ordinary cool tap- water should be employed ; and it is Avell to remem- 
ber that the secret of successful sponging lies in the use of a sponge 
not saturated to overflowing, but only sufficiently wet to leave a thin 
film of moisture on the skin which cools the patient by its rapid 
evaporation and does not wet the clothes and the bed. 

There are many cases where sponging, even with ice-water, fails to 
reduce the fever, and in these the fever must be lowered by the " cold 
pack," as it has been called. The name is unfortunate, as it is indica- 
tive of a very severe exposure, which really does not occur. The 
application is carried out as follows : 

A small canvas cot should be placed by the side of the bed of the 
patient and covered by a large rubber cloth, which, by being raised 
at the head and depressed at the foot, forms a channel for the water. 
Over this, again, is placed an ordinary sheet. The patient, after being 
stripped, is laid upon this sheet, which is then folded over him, and a 
fine spray from an ordinary watering-pot for flowers allowed to play 
upon his body from end to end. The temperature of the water de- 
pends upon the effect required. The bed should be so arranged that 
the water w 7 ill not remain in puddles under the patient, but drain off 
constantly into a bucket at the foot. The sheet being wet allows 
evaporation to go on, and a rapid fall in the fever results. 

It is of the greatest importance that the attendant lightly but 
briskly rub the patient all over with the hands, so as to bring the 
blood to the surface and prevent internal congestions. 

During this procedure the thermometer should be placed in the 
mouth or pushed deeply into the rectum, and the fall in the tempera- 
ture watched. As soon as it reaches 101° or 100° F. the bath must 
cease, lest the fall continue and collapse ensue. 

On the removal of the patient the surface should be gently dried 
with towels, and the bed -clothing consist of only a sheet, or a sheet 
and one blanket in cold weather. Above all things, it must be re- 
membered that the patient is not to be wrapped up in a blanket, and 
not only this, but that he must not be placed in a blanket while still 
in a wet sheet. The wet sheet, if surrounded by a blanket, soon 
places the patient in a typical Russian or warm moist bath, calculated 
to raise instead of lower the fever. 

Where sunstroke (thermic fever) is present the patient may have 
chopped ice applied or be put directly into a bath-tub of ice-water, 
but in any event the attendants must rub the patient's skin to bring 
the hot blood to the surface and prevent congestions. 

The treatment of rheumatic hyperpyrexia by cold is quite as suit- 
able as is this treatment of other • fevers, whenever the hyperpyrexia 
is so excessive as to endanger life. 

The presence of pneumonia and bronchitis does not seem to contra- 
indicate the use of cold in fevers, and no fear of " cold'' being taken 

23 



354 REMEDIAL MEASURES OTHER THAN DRUGS. 

need exist unless the bodily temperature is lowered below the normal 
point or to one degree above it. According to Liebermeister, intes- 
tinal haemorrhages contra-indicate the use of cold, but this statement 
has been contradicted by no less a writer than Wunderlich. 

(For Brand's cold treatment of typhoid fever, see Typhoid Fever.) 



COUNTER-IRRITATION. 

Counter-irritation is a term applied to the use of substances irri- 
tating to the surface with which they come in contact, and employed 
for the purpose of influencing morbid processes in more or less distant 
parts, or of affecting the general system. It has been thought that 
this method savors of the doctrine of "like cures like/* but in reality 
it is based on sound physiological laws, and is so logical as to have 
been described by the founder of homoeopathy as useless. 

The entire basis for the employment of counter-irritation rests upon 
reflex action, or the conduction of a nervous impulse to a centre, which, 
when so stimulated, sends out an impulse to the part of the body 
which is diseased. 

The use of counter-irritation may be divided into four parts or pur- 
poses. The first is for affecting inflammations or congestions, the second 
for .causing the absorption or removal of inflammatory deposits after 
true inflammation has ceased ; while the third purpose is for the relief 
of pain, and the fourth for the effect which can be exercised upon the 
general system by blisters in systemic disease. 

In the same manner that we can divide the indications for counter- 
irritation into four parts, so can we also divide its forms into three 
varieties, according to their severity. The most severe are the caus- 
tics or escharotics, the next the epispastics or blisters, and finally the 
rubefacients or reddeners. 

The proper manner of employing a counter-irritant to affect inflam- 
mations is not to apply it directly to an inflamed area, but a little to 
one side of it or at a spot known to be connected intimately with the 
diseased area by nerve fibres. 

Thus, it is well known that in diseases of the eye the blister should 
be applied back of the ear, and that in abdominal neuralgia or in 
pleurodynia the best results are reached, not from the application of 
a blister to the spot where the pain is felt, but to the point upon the 
vertebral column where the nerve at fault takes its exit. The reason 
for this is that pain is always referred to the peripheral end of an irri- 
tated nerve, and pleurodynia or abdominal pain often arises from ver- 
tebral disease or inflammation about the spinal ligaments or the fora- 
mina of exit for the nerves. In a similar manner we sometimes apply 
a blister, in the early stages of hip-disease, not to the knee or ankle, 
where the pain is felt, but at the seat of the trouble, namely, the hip. 
Counter-irritation is contra-indicated by the presence of any acute 
inflammation directly under the spot where it is proposed to place a 
blister — that is, if any reddening of the skin is present the blister or 



COUNTER-IRRITATION. 355 

other form of irritation must not be applied there. If used at all, it 
must be some little distance away, or a series of small flying blisters 
should be placed around the inflamed zone. A flying blister is one 
which is small in area — say as large as a Lima bean — and of compara- 
tively slight action, healing rapidly after its effects have passed by. 

Among the inflammatory affections in which we find counter-irrita- 
tion most serviceable may be mentioned pleurisy, pneumonia, iritis, 
synovitis (rheumatic or traumatic), cerebritis aud peritonitis (acute or 
chronic). A host of more subacute or chronic inflammations are also 
benefited by this measure, some of which are gleet, chronically en- 
larged joints, and inflamed glands In all these states the blister, or 
more rarely, the rubefacient, is to be resorted to ; and while it is true 
that nearly all of these conditions are accompanied by fever, and that 
fever is generally held to be a contra-indication to the use of counter- 
irritation, blisters undoubtedly do good at such times. In pneumonia 
or pleurisy, along with the use of veratrum viride, a cantharidal blister 
of the size of a silver dollar should be applied near the spot where the 
most pain is felt or on the back near the spine. Where joints are 
inflamed, the blisters should be at some distance from the seat of the 
swelling, although it is often useful to place the counter-irritant on 
the inner or outer aspect of the knee-joint, if the skin is not reddened. 
In peritonitis the blisters are best applied directly over the seat of 
tenderness, and, in cerebritis, at the nape of the neck. In gleet a 
little cantharidal collodion may be painted along the under surface of 
the penis or upon the perineum with great advantage in obstinate 
cases. 

Where inflammation is chronic and resists cantharidal blistering, 
then resort is often had to more severe forms of counter-irritation by 
means of the red-hot, not white-hot, iron, or the use of escharotics, 
such as caustic potash or soda, or arsenic. The reason for using these 
is that they all cause so much tissue-change in the part that the coun- 
ter-irritation is very prolonged. Sometimes antimonial ointment is 
applied constantly, until a slough forms, to accomplish the same pur- 
poses. 

For the removal of the products of inflammation we resort to can- 
tharidal blisters or drugs possessing powers as local irritants and at 
the same time as alteratives. Thus, in pleurisy with effusion it is 
very proper to employ a good-sized cantharidal blister if the effusion 
has a tendency to remain unabsorbed. Some have thought that the 
absorption which follows is due to the abstraction of serum which 
takes place in the bleb formed, but this is a mistaken idea, as one often 
sees an effusion absorbed which far exceeds in quantity the amount of 
liquid in the blister. Under these circumstances, the spot for apply- 
ing the blister is, as a rule, immediately under the arm, about two or 
three inches below the axilla. The blister, while it is useful in caus- 
ing absorption in chronic effusions and deposits about joints, is not so 
good as are alterative irritants — for example, as iodine, which in the 
form of a thorough application at one sitting until the skin is black — 
not yellow or red — is often of service. In other cases, particularly 



356 REMEDIAL MEASURES OTHER THAN DRUGS. 

in very chronic states, iodine ointment, alone or with lard, may be 
rubbed into the parts with advantage, care being taken to stop its use 
for a day or two as soon as the skin gets red. This same treatment is 
also useful in treating enlarged glands in the neck and elsewhere. 

One of the best treatments for epididymitis is to paint the scrotum 
black with many coatings of a strong solution of silver nitrate or 
iodine, to insist on total rest in bed, and to resort to the local use of 
cold. The testicles should also be supported by a suspensory or 
adhesive strips during this treatment, and aconite given if fever is 
present. 

For the relief of pain we very commonly resort to the rubefacients 
rather than epispastics, since the more moderate applications are equally 
effective in most instances and do not leave evil effects behind to remind 
the patient of his attack. 

Everyone who has had stomach-ache and remembers the relief 
obtained by the use of a mustard plaster or spice plaster, recognizes 
the value of this means of obtaining relief, and it only remains for 
the writer to state that headaches are often amenable to similar treat- 
ment. These headaches may be neuralgic or due to dyspepsia or to 
cerebral ansemia or congestion, but counter-irritation will nevertheless 
do good. If neuralgic, a little menthol or oil of peppermint may be 
applied over the course of the nerve — which application, if the pain 
be supra-orbital, will require care lest the oil gain access to the eye. 

For the treatment of pain in the belly or chest or elsewhere we 
have four methods of applying counter-irritation in the shape of 
rubefacients. The first is mustard ; the second, capsicum ; the third, 
the spice poultice ; and the fourth, the turpentine stupe. 

The mustard plaster should be made by mixing mustard flour with 
warm vinegar or water, and adding varying proportions of ordinary 
flour to modify its action. If the skin is tender, half mustard and 
half wheat-flour may be employed, or, if a child is to be treated, the 
proportion may have to be one-fourth mustard. The plaster is made 
by placing a newspaper on a table and putting over it a piece of 
heavy muslin or linen. On this is smeared the mustard, and over 
the mustard mass is placed a more or less thin piece of linen, which 
prevents the poultice from adhering to the skin and modifies the 
burning according to its density. By folding the edges of the news- 
paper so that it resembles a picture- frame we have at hand a cheap, 
effective and strong plaster, the back of which is supported by the 
newspaper. 

The spice plaster is made by mixing equal parts of allspice, cloves, 
cinnamon, and nutmegs, and adding thereto J part of black pepper. 
These constituents are made into a homogeneous mass by using a knife- 
blade to mix them, and are then sewed up in a bag which is quilted 
to prevent sagging of the contents. One side of the poultice is now 
wetted with warm brandy, whiskey, or vinegar, and applied to the 
part desired. 

If the skin is tender, the proportions of pepper and cloves should 
be decreased. 



DISINFECTION. 357 

This plaster may be allowed to remain over the affected parts for 
hours or even days, and it is very useful in the treatment of gastric 
catarrh and indigestion, particularly that occurring in children. 

The turpentine stupe (see Turpentine) is not to be allowed to 
remain very long on the skin, as it may blister a tender cuticle, and 
the pepper plaster may be so active as to produce unbearable pain 
if it is not watched. 

The proper way of treating all such burns from counter-irritation 
is to apply simple cerate, cosmolihe, or sweet oil, to which may be 
added carbolic acid in the proportion of 1 to 100. The carbolic acid 
not only acts as an antiseptic but as a local anaesthetic, while the oil 
acts as a protective from contact with the air. 

Much difference of opinion exists as to the proper treatment of the 
blister formed by cantbarides. Where the blisters are small — that is, 
the size of the end of a finger — they may be allowed to break of them- 
selves, and then be dressed with dry cotton ; if they are large, the 
blebs should be punctured at their most dependent part with a needle 
and dressed with dry absorbent cotton, as by so doing the new skin 
rapidly forms underneath and is soon able to carry on its normal 
functions. 

The proper treatment of the blister while it is forming is to apply 
a poultice, which will decrease the pain and aid in the formation of 
the bleb. 

DISINFECTION. 

Before discussing the subject of disinfection we must turn our 
attention to what we mean by the terms employed when speaking of 
this subject in general. At present we recognize universally that the 
word germicide is a term applicable solely to agents capable of kill- 
ing the lower forms of life, whereas antiseptics are substances which 
simply render the material with which they come in contact so 
antagonistic or unsuited to germ development as to render their 
presence for any length of time impossible, at least in an active state. 
To use a simile : the killing of the inhabitants of a district by shoot- 
ing them would stop all growth and be germicidal, whereas the 
destruction of crops in these same parts would only be antiseptic ; or, 
in other words, the people might remain, but would either have to go 
elsewhere or starve to death. (See article on Antiseptics.) 

We now speak of germicides as disinfectants, but never of anti- 
septics as disinfectants, if we use these terms correctly. Germicide 
and disinfectant are therefore synonymous words. 

From what has just been said it is evident that we should always 
resort to disinfectants rather than antiseptics, for although the latter 
are good the former are better. 

We have three ways of destroying germs which are particularly 
useful. The first is the total destruction not only of the germs, but 
also of their resting-place, by means of fire, which may be used in 
the case of old furniture, mattresses and similar materials, and which 



358 REMEDIAL MEASURES OTHER THAN DRUGS. 

may be extended to everything about the patient, if it is necessary 
to stamp out a brisk epidemic before it can get well under way. The 
second is the use of moist heat in the form of superheated steam, or, 
better still, for common purposes, the use of boiling water ; and, 
thirdly, by means of disinfectant materials which have a proved 
reliability. 

Moist heat in the form of superheated steam is infinitely prefer- 
able to dry heat, but as superheated steam cannot be readily obtained, 
physicians usually direct the clothes to be boiled for at least two 
hours. 

Very often the bed-clothes are taken from a sick-room, trailed 
through the house, and finally deposited at any spot until a convenient 
time for boiling them occurs. This is radically wrong and capable 
of causing a widespread distribution of the disease. In all such cases 
the bed-clothes should be rolled off the bed in a bundle and com- 
pletely submerged in a bucket or tub of boiling water, or, better still, 
in a corrosive sublimate solution of the strength of 1 to 1000, before 
they are taken from the room. This tub is now to be carried at once 
to the fire and the clothes lifted out dripping wet and plunged into a 
clothes-boiler in which the water is actively boiling. The lid of the 
boiler is at once to be put on to increase the heat and prevent the 
escape of any germs in the steam or in the hot air which arises from 
the surface of the water. The active boiling should be continued for 
one or two hours, and water be continually added to prevent scorching 
of the contents of the boiler. 

It is important that food be not cooked on the stove at the time 
the clothes are being boiled, and no food should be in the room. 

If boiling cannot be resorted to for any reason, the clothes may be 
soaked in a 1 to 500 solution of corrosive sublimate or a 1 to 20 solu- 
tion of carbolic acid, although neither of these is so sure a method of 
disinfection. 

The proper care of a room after it has been occupied by a case of 
infectious disease is of great importance and is generally sadly mis- 
managed. Very commonly sulphur is burnt, and this, as commonly 
employed, is perfectly useless, owing to leaking windows and doors 
which permit most of the generated gas to escape. 

To be of any value, the burning of sulphur must be preceded by 
packing the window- and door-cracks with cotton or soft paper. 
Broken rolled-sulphur is moistened with alcohol, which is then 
lighted. 

By far the best method of disinfection is to take all movable objects 
out of doors into the fresh air and then to wash the floor, sills, and 
casings, using a scrubbing-brush, hot water, and soap. The water 
remaining in the bucket should afterward be boiled to kill the germs 
which may be in it. This scrubbing being accomplished, the same 
surfaces should be scrubbed a second time with a solution of corrosive 
sublimate (1 to 500 or 1 to 1000), and left wet so that the salt of mer- 
cury may remain on them. Cracks and crannies are to receive par- 



DISINFECTION. 359 

ticular attention. It corrosive sublimate cannot be used then carbolic 
acid (1 to 10 or 1 to 20) may be resorted to. 

By far the best disinfectant for all diseases is good ventilation. ISTot 
only should as much air as possible be allowed to enter the sick room, 
but after the case has vacated the premises the windows should remain 
open for weeks, if possible. Fresh air dilutes germs as fresh water 
dissolves or dilutes dirt. 

Disinfection of the discharges of the patient is an important duty 
to be remembered. The urine and faeces should always be received 
in a vessel containing enough corrosive sublimate solution (1 to 500) 
to kill all germs and to prevent their escape into the air or into water 
or food when the discharges are thrown away. The disinfectant should 
be placed in the bed-pan before, not after, it is used. 

The bed-pan or chamber should not be allowed to stand in the 
room, but be removed and emptied at once in such a manner that it 
cannot contaminate any water or food. It should not be thrown upon 
the ground, as the air will dry it and cause the germs to fly in the 
form of dust anywhere and everywhere. In very contagious diseases 
bathing or swabbing-off the patient with weak antiseptics may be 
tried. Thus 1 to 10,000 of bichloride of mercury may be used and 
the patient afterward wiped off with a wet towel. » 

The question as to which are the best disinfectant substances is 
one which has attracted the attention of physicians and original in- 
vestigators for years. The result of a vast amount of study and 
experience shows that corrosive sublimate is the best of all disinfect- 
ants in the proportion of 1 to 250 to 1 to 500, or even weaker, and 
that for cheapness, activity, and general usefulness chlorinated lime 
is better still. The disadvantages in the use of corrosive sublimate 
lie in its ready decomposition, its formation of an albuminate when 
albumin is present, its uselessness where lead pipes are present, and 
above all its expense. Chlorinated lime depends entirely upon its 
chlorine for any disinfectant power which it may possess. Chlorine 
gas itself is not readily handled, but the lime enables us to put it 
where we will. It cannot be employed to disinfect colored fabrics, as 
it bleaches them. 

Whenever chlorinated lime is bought the physician should see that 
all its chlorine has not departed from it, as most of the material kept 
in the stores is so old as to be worthless. 

For scrubbing floors, chlorinated lime may be made into a solution 
by adding a cupful to a bucket of water, and in privies it may be 
spread thickly over the surface of the mass of filth. 

It is useless to place chlorinated lime around the room for the 
purpose of disinfecting the air, as the amount of chlorine to the 
volume of air to be disinfected is as nothing. 

Copperas, or sulphate of iron, while largely used as a disinfectant 
by some persons, is in reality only an antiseptic. 



360 KEMEDIAL MEASURES OTHER THAN DRUGS. 



HEAT. 

Heat is used locally for a number of purposes in the same mauner 
as is cold, and, as was stated in the article on Cold, the choice of heat 
or cold, in the treatment of any acute form of inflammation, depends 
almost entirely upon the wish of the patient, who generally can tell 
at once which will give him the greatest comfort. 

In sprains of the ankle nothing compares to a hot foot-bath pro- 
longed for hours, the object being to decrease the pain and swelling, in 
order thereby to rapidly regain the use of the limb. To carry this out 
effectively a piece of rubber tubing of small size should be led from 
a wooden bucket, which being a bad conductor of heat prevents the 
water from being rapidly chilled, to a sink or large tub near by, when 
by starting the water by suction a continuous but very small stream 
can be made to flow from the bucket ; while by means of another 
similar arrangement running either from another tub, or, better still, 
from a hot-water spigot, a small stream of hot water continually enters 
to take the place of that withdrawn by the first siphon. Under these 
circumstances a very constant temperature of the water can readily be 
maintained. The Jhigh degree of heat which can be borne, by gradu- 
ally increasing the temperature of the water in the supply tube, is very 
extraordinary, the favorable results obtained being in direct ratio to 
the height of the temperature. Between these soakings the part should 
be dressed with lead-water and laudanum, and rubbed now and then 
with camphor liniment containing laudanum. 

In spasmodic affections involving either striped or unstriped mus- 
cular fibre the local application of heat is a very useful means of 
relief. Sometimes in lumbago or muscular stiffness in other parts of 
the body the use of an ordinary laundry iron over the affected part 
will prove of great service, the skin being covered by several layers 
of newspaper to afford a smooth surface over which to pass the iron 
and to protect the parts from too great heat. 

In chordee the best means for rapid relief, other than the use of 
drugs or general relaxants, such as amyl nitrite, is to steep the penis 
in hot water. A hot sitzbath before goiug to bed is a good prophy- 
lactic against this painful complication of gonorrhoea. 

In croup of the spasmodic type the local application of a hot com- 
press, made by wetting spongiopiliue with hot water, is very useful, 
or, if spongiopiliue cannot be had, several layers of flannel should be 
wetted, placed on the neck, and covered with cotton and oil-silk so as 
to prevent the roll from becoming chilled. 

Where attacks of dysmeuorrhcea depend upon spasmodic closure of 
the cervix, with simultaneous spasm of the fundus uteri, a hot sitz- 
bath or vaginal injection is useful, and this treatment is also of value 
where uterine congestion results in leucorrhoea or a sensation of weight 
in the pelvis. Sometimes attacks of torticollis may be subdued by 
applying hot compresses to the sterno-mastoid muscles. 

In universal or partial spasm of the body, as well as that represented 



HEAT. 361 

by chorea, a hot pack is of great service, and it is to be used in the 
following manner : The child having first been stripped of all clothing 
is placed upon a bed which is covered by a rubber blanket and imme- 
diately wrapped in a woollen blanket which has been dipped in hot 
water and the excess of water wrung out of it Over this wet blanket 
is immediately wrapped a dry one, to retain the heat, and very soon 
the patient begins to perspire freely. Care should of course be taken 
that the temperature of the patient does not rise too high before 
sweating comes on. This hot pack will sometimes quiet a case of 
chorea which has resisted all forms of treatment so far as drugs are 
concerned. Cases of insomnia are often benefited by a similar expe- 
dient, and mild cases of sleeplessness will occasionally rest quietly after 
an ordinary hot bath. 

A wet pack which speedily becomes a warm one is used in cases 
where, during the course of an eruptive fever, the eruption fades and 
it is desired to bring it out on the surface. It is also useful in those 
cases of severe chorea in which the child can stand the first shock of 
the cold. It consists in wrapping the child in a cold wet sheet and 
over this wrapping one or two blankets. In a few minutes the sheet 
becomes heated from the body and the sweating which results is pro- 
fuse. 

Cold may be applied to the head to relieve cerebral hyperemia and 
to prevent overheating during this treatment. 

The use of heat in two forms has been and is largely used at present 
for medicinal purposes, when the kidneys or skin are torpid, to aid in 
the elimination of impure and eifete materials from the blood and 
tissues. These two forms of heat, the dry and the moist, are commonly 
called the Turkish and Russian baths respectively, and may be taken 
under home arrangements or in one of the establishments found in all 
large cities. 

The first of these is in the form of dry heat, the second is moist 
heat. The Turkish bath consists of a series of rooms ranging in tem- 
perature from 100° F. to 150° F. or more, into which the individual 
passes successively until the hottest room is reached. In each chamber 
he lingers until the system becomes accustomed to the high temperature, 
and perspiration is well established before he enters the hottest room, 
where he remains for a varying length of time, according to the advice 
of his physician or his own whini or comfort. The rule governing 
his stay is, that he must leave it at once if any sense of oppression is 
experienced or if perspiration does not flow freely. Sometimes a glass 
of cold water taken at this time causes a sudden profuse sweat, and 
also relieves any overheating by abstracting many units of heat. The 
cold water in the centre of the body causes contraction of the blood- 
vessels in these parts, and the blood rushing to the surface causes the 
sweat-glands to pour out their secretion. 

Following the stay in the warm room the individual passes into 
still another chamber, where he is shampooed from head to foot, well 
rubbed, and the blood made to circulate through the skin. The 
shower-bath is then used, at first hot or warm and finally changed to a 



362 REMEDIAL MEASURES OTHER THAN DRUGS. 

dash of cold, or, better still, the patieDt plunges into a long tank, swims 
to the other end, and is there met by an atteodent who rapidly dries 
his skin, wraps a cover round him, and shows him to a lounge, where 
he is supposed to recline and sleep for an hour or less. The air of 
this sleeping-room is at the ordinary temperature of a living-room. 

Reviewing for a moment the effects of this bath, we find that the 
first two-thirds are devoted to the opening and stimulation of the 
pores of the skin, while the last third is devoted to the contraction of 
these pores and their supplying bloodvessels. In other words, it is 
necessary to use the cold to prevent gradual chilling of limited areas, 
which would result in internal congestion. If the patient receives a 
cold douche the natural rebound prevents congestion of a permanent 
nature, whereas if he is exposed to cold a long time these stagnated 
areas become permanently diseased. The physician must always re- 
member that this cold douche or plunge is a sine qua non, and that a 
rest after the bath before dressing is almost equally important. If 
the patient is too w r eak to bear the cold he must not use the bath. 

The indication for the Turkish bath, as a medicinal measure, is any 
condition of the emunctories of the body, whereby effete matters are 
not properly eliminated, as in Bright's disease in its various forms. 
The increased action of the skin not only casts off impurities for the 
time being, but frequent repetition of the bath causes functional 
hypertrophy of the sweat-glands, and eventually enables them to do 
more work, or, in other words, to cast off an increased quantity of 
effete material. As a consequence of this the patient is able to avoid 
uraemia or other evidences of Bright's disease, and, employing the 
normal epithelium still left in the kidney for constant use, uses the 
the bath once, twice, or thrice a week, with the object of abstracting 
the excess of impurities which the impaired activity of his kidneys 
cannot remove. The frequency of the bath depends, therefore, upon 
the rapidity with which the effete materials accumulate. In cases of 
Bright's disease the patient should not attempt to use the room con- 
taining high heat at first, and should be accompanied by a medical 
attendant to watch for untoward effects, particularly if the heart is 
diseased or uraemia is already shown by headache or other signs. 
If sweating does not come on at once, danger is at hand from acute 
uraemia, renal and cerebral congestion, or heat-stroke. 

Not only is the Turkish bath useful for kidney disease, but it is 
often of great service in rheumatism. The acute form of rheumatism 
is rarely so treated, because cardiac complications often forbid ex- 
posure to heat, and fever is generally present. In subacute and chronic 
rheumatism the case is different, and the enlarged joints or inflamed 
muscles yield like magic in some instances to such treatment. Fur- 
ther than this, the muscular stiffness following prolonged or severe 
effort can be so avoided, and neuralgia depending upon rheumatic or 
gouty taint may be relieved by the hot-air bath. 

Acute colds affecting the head or elsewhere, if taken at an early 
formative stage, can often be aborted by a i*ood Turkish bath, and 
when further developed, greatly relieved by the same means. If, 



HEAT. 363 

however, congestion of the lung, pneumonia, or chronic bronchitis, 
with emphysema or a dilated weak heart, are present, the bath may 
be dangerous. In acute pharyngitis, iu which the pharynx feels like 
a raw surface, or "as if it were filed or scraped," the bath will give 
relief in many instances. 

Sometimes in suppression of menstruation from cold the flow may 
be restored by a Turkish bath. 

Some persons complain that they are always catching cold upon 
the slightest provocation, and apparently without cause. One class 
seem to have delicate mucous membranes readily susceptible to irri- 
tation and inflammation, the other have dilated or relaxed peripheral 
capillaries, which readily allow the blood in them to become chilled, 
and, consequently, suffer from internal local congestions. Two sepa- 
rate means of treating such cases exist. The first set will do well on 
minute doses of arsenious acid (grain -j-j-^- to ^-q) three times a day, 
used for weeks ; the second will be cured of their habit by the use of 
a Turkish bath twice or thrice a week, since by this means the periph- 
eral capillaries are toned up and made more active. 

The Turkish bath, as thoroughly carried out in large cities, is not 
obtainable for those living elsewhere, so it is well to describe a home 
modification which, with attention to detail and care, may prove almost, 
if not quite, as effective a remedy. 

The patient is placed upon a wicker chair, naked, and under the 
chair a small alcohol lamp is put, which is lighted. The individual 
is now wrapped thoroughly, chair and all, with one or two large 
blankets, and the heat of the lamp soon causes profuse sweating. 
Many cases are, however, on record Avhere the lamp has been upset 
and the patient badly burned. The eminent physiologist, Dr. Car- 
penter, so met his death. The best way is to have the lamp a little 
to one side and its flame immediately under the mouth of an inverted 
funnel attached to a piece of tin tubing, the free end of which is 
placed under the blanket so that the hot air and vapor may surround 
the body. If the tube be covered with cloth the loss of heat is slight 
and the danger of burning the patient is removed. If this is not 
practicable several very hot bricks or stones, thoroughly heated in an 
oven, may be placed under the chair, or small heated logs may be 
substituted. 

The Russian bath differs from the Turkish in that the heat used 
is moist, not dry. As a consequence the danger of heat-stroke and 
similar states is much increased, because evaporation from the skin 
does not go on so rapidly and the body is not cooled so well in con- 
sequence. In its place the patient may be given a warm pack, which 
consists in wrapping him in a sheet and surrounding him w r ith large 
blankets wrung out of water as hot as can be borne, which is in turn 
covered with a dry blanket to prevent cooling. 

This method of treatment is useful in the same states as is the 
Turkish bath, but is more rarely used. The warm pack just named 
is also employed to develop the rash of any of the exanthematous 
fevers when it is suppressed by cold or is not "well out" on the skin. 



364 REMEDIAL MEASURES OTHER THAN" DRUGS. 

The temperature of the patient must be watched lest he fails to have 
sweating and develops heat-stroke in consequence. A thermometer 
should be kept constantly under the tongue during the use of the pack. 

The hot moist bath can also be obtained by placing a patient on 
a wicker chair, under which is placed a bucket of hot water. The 
patient is surrounded by a blanket, and a hot iron or stone is put into 
the water, causing the development of a great amount of steam. 

Whenever the Russian bath is used, except in the exanthematous 
fevers, it should be followed by a cold douche. 

Although these baths have been used in the treatment of cases of 
heart disease to relieve dropsy aud renal engorgement they are not 
safe and should not be generally employed. All acute or chronic 
diseases of the lung, except acute bronchitis of a mild form, contra- 
iudicate their use. 

Kalashnikoff has made a series of observations on the therapeutic 
effects of heat on syphilis, and especially on syphilitic eruptions, his 
patieuts being inmates of the St. Petersburg Lock Hospital for 
Women and Children. The heat was applied where possible by 
means of partial hot-air baths applied to the affected part for half an 
hour twice a day, the part being enveloped in hot flannel immediately 
afterward, and remaining so protected until the next hot-air bath. 
The temperature never exceeded 116° F. (46.6° C). When the 
eruption was on the back or neck or on some part which it was 
impossible to insert into a hot-air chamber, India-rubber hot-water 
bottles or tubes, through which the hot water was kept flowing, were 
employed. When both arms or legs were affected in a symmetrical 
manner the treatment was confined to one side, the other being left 
untreated for the purpose of comparison. The results showed that 
the heat treatment acted very energetically and beneficially on sypki- 
lides, both when employed alone instead of mercurials and iodides, 
and also when used in conjunction with these remedies. Often heat 
proved beneficial when the ordinary specifics had failed. Among 
other observations it was noted that hard chancres healed and the 
induration disappeared in from 8 to 16 days; roseola and papular 
erythema disappeared in from 4 to 8 days ; various forms of papular 
and impetiginous syphilides, with marked pigmentation, disappeared 
in from 8 to 21 days ; non-ulcerated tubercles and gummata disap- 
peared in from 7 to 24 days, but those which had already begun to 
ulcerate required from 1 to 6 w r eeks ; periostitis was cured in from 10 
to 24 days ; ostoses were not affected ; syphilitic ulcers, consequent on 
the breaking down of gummatous periostitis, required treatment of 
from 6 weeks to 3 months or more, while necrosis of bone frequently 
required many months' treatment before the sequestra could be got 
away. 

INTRAVENOUS INJECTION. 

Intravenous injection is a method which is to be employed only 
under extraordinary circumstances and with only a few drugs. Thus 



LEECHING. 365 

in the case of snake-bite it may be advisable to resort to such an 
injection of diluted aqua ammonia or ether, or even warm brandy or 
whiskey. Under these circumstances the injection should be made 
into a vein in the leg rather than one in the arm, as the drug under 
these circumstances does not reach the heart in so concentrated a form 
and cardiac depression is thereby avoided. 

The objections to intravenous injections are several. In the first 
place the veins are apt to be collapsed and hard to find, and it is still 
more difficult to puncture one without wounding the opposite wall of 
the vessel. Again, phlebitis is a very probable sequel and thrombosis 
and embolism are by no means impossible. 

It is needless to say that the solution which is injected into a vein 
should always be of a neutral or alkaline reaction in order to avoid 
coagulation of the blood. (See Transfusion.) 



KATAPHORESIS. 

By the term kataphoresis we mean a method resorted to by physi- 
cians having for its purpose the introduction into the body of drugs 
through the influence of electricity. Correctly speaking, kataphoresis 
is an osmosis of medicaments through the tissues, the osmosis being 
carried on by the electrical current and the drug being carried through 
the tissues between the two poles. Quinine, iodide of potassium, the 
various soluble salts of mercury, and chloroform and ether may be so 
used. The ordinary sponges or absorbent cotton tips of the electrodes 
may be saturated with the medicament to be used, and the constant 
current employed, the current being reversed every few minutes. The 
positive pole of the battery is placed over the affected part, and the 
negative at a little distance away. 

In cases of neuralgia, chloroform and alcohol, of each one-half, or 
even pure chloroform, may be employed, and in syphilitic nodules, 
when the patient's stomach cannot bear drugs, kataphoresis over the 
part affected, with iodides, may be resorted to. The iodide of lithium 
is commonly employed in the strength of 5 per cent, in these cases. 
The strength of the current depends upon the size of the electrodes 
and the sensations of the patient. It is not necessary to use a stronger 
current than the patient can bear with comfort. 



LEECHING. 

Leeching is a method of abstracting blood for the purpose of re- 
lieving local inflammations or acute congestions. There are two 
forms of leech commonly employed in medicine, both of which are 
imported. A small leech is found in many streams in the United 
States. Leeches, after attaching themselves to the skin by means of 
their sucking apparatus and teeth, secrete a liquid which prevents 



366 REMEDIAL MEASURES OTHER THAN DRUGS. 

coagulation of blood, and this accounts for the persistent haemorrhage 
sometimes seen after a leech-bite. 

Therapeutics. — The reasons for using venesection or depletion have 
already been considered, and we can therefore pass directly to the 
uses to which leeches are put. In cases of meningitis they may be 
applied to the temples or to the nape of the neck, and in the treatment 
of swollen joints such as occur after sprains they are useful. In orchitis 
they should not be placed upon the scrotum but on the perineum ; in 
conjunctivitis or inflammation of the eye, upon the temple or back of 
the ears, not upon the lid itself. 

Employment. — Leeches if singly applied may be placed on the skin 
under an inverted wineglass or under a large pill-box. If they will 
not take hold, a little sweetened milk may be placed on the skin or a 
drop of blood extracted from the finger may be placed there. In all 
cases the skin should be carefully washed before the leech is used. 
When they have taken enough blood they can be made to let go their 
hold by sprinkling them with salt. Each leech will take about 1 
drachm of blood. Leech-bites should be watched lest prolonged con- 
secutive bleeding exhaust the patient. In case of such an accident 
styptics are to be employed. As leech-bites make permanent scars, the 
animal should not be applied on the face or other exposed surface. 



REST CURE. 

The rest cure, so called, is a method devised and elaborated by Dr. 
S. Weir Mitchell, of Philadelphia, for the relief of a large class of 
patients who, for various reasons, are generally ailing from apparently 
no organic disease, and yet whose condition is often so alarming as to 
lead to the belief that some hidden cause of a severe train of symp- 
toms must be present. In many such instances a careful study of 
the case will show that there is a cause, near or remote, which has ex- 
hausted the patient's vital forces without producing auything else than 
functional disturbances of the body. Thus a prolonged nerve-strain 
in nursing a sick relative may so exhaust the streugth of a hitherto 
healthy woman as to produce hysteria, anaemia, and great disturbances 
of nutrition, or, in another instance, cause neuralgia, disordered men- 
struation, and uterine or ovarian pain. In males, mental, sexual, or 
physical vigor may be impaired owing to prolonged anxiety in business. 
Be the symptoms what they may, as long as they are dependent upon 
nerve-strain this "cure" is to be resorted to, and if properly carried 
out is often blessed with surprising results. Before describing the 
method in detail it is proper to state that the entire rationale rests 
upon the remembrance that every movement is an expenditure of 
force, and that a system which has already overdrawn its reserve 
fund of strength must be no more prodigal with the funds that 
remain than a bank should be under the same circumstances. 

It having been decided that the rest cure is to be employed, the 
directions are given as follows : 



BEST CURE. 367 

A bright, airy, easily-cleaned and comfortable room is to be selected, 
and adjoining it, if possible, should be a smaller one for an attendant 
or nurse. The patient is put to bed and kept there for from three to 
six weeks as may be necessary, and during this time is allowed to see 
no one except the nurse and the doctor, since the presence of friends 
requires conversation and mental effort. The patient, in severe cases, 
must be fed by the nurse in order to avoid the expenditure of the force 
required in the movements of the arms. ~No sitting up in bed is 
allowed, and if any reading is done it must be done by the nurse, 
who can read aloud for an hour a day. 

In the case of women the hair should be dressed by the nurse to 
avoid any physical effort on the part of the patient. 

To take the place of ordinary exercise two measures are employed, 
the first of which is massage or rubbing of the body, the second, 
electricity. By the kneading and rubbing of the muscles and skin 
the liquids in the tissues are absorbed and poured into the lymph 
spaces and a healthy blush is brought to the skin. This passive ex- 
ercise is performed in the morning or afternoon, and should last for 
from a half to one hour, every part of the body being kneaded, even 
to the face and scalp. In the afternoon or morning the various mus- 
cles should be passively exercised by electricity, each muscle being 
made to contract by the application of the poles of the battery to its 
motor points. Both these forms of exercise do not call for any ex- 
penditure of nerve force, though they keep up the general nutrition. 
The following programme, for a day's existence, is an example of 
what the physician should order : 

7.30 a.m. Glass of hot or cold milk predigested, boiled or raw, 
as the case requires. 

8 a.m. The nurse is to sponge the patient with tepid water, or 
with cold and hot water alternately, to stimulate the skin and circu- 
lation, the body being well wrapped in a blanket, except the leg or 
portion which is being bathed. After this the nurse should dry the 
part last wetted with a rough towel, using some friction to stimulate 
the skin. 

8.30 a.m. Breakfast. Boiled, poached, or scrambled eggs, milk 
toast, water toast, or a finely-cut piece of a mutton-chop or chicken. 

10 a.m. Massage. 

11 a.m. A glass of milk, or a milk-punch, or egg-nog, 

12 m. Reading for an hour. 

1 p.m. Dinner. Small piece of steak, rare roast beef, consomme 
soup, mutton broth, and any one of the easily digested vegetables 
well cooked. 

3 p.m. Electricity. 

4.30 p.m. A glass of milk, or milk-punch, or egg-nog. 

6.30 p.m. Supper. This should be very plain, no tea or coffee, but 
toast and butter, milk, curds and whey, or a plain custard. 

9.30 p.m. A glass of milk or milk-punch. 

In this way the day is well filled, and the time does not drag so 
heavily as would be thought. If the stomach rebels at over-feeding, 



363 REMEDIAL MEASURES OTHER THAN DRUGS. 

the amounts of food must be cut down, but when all the effort of the 
body is concentrated on respiration, circulation, and digestion, a large 
amount of nourishment can be assimilated by the exhausted body 
which before this treatment is undertaken may have its resources so 
scattered as to be unable to carry out any physiological act perfectly. 

For the treatment to be successful the rules laid down should be 
rigidly followed and never remitted for a single hour. 



SUSPENSION. 

The treatment of locomotor ataxia and allied affections by means of 
suspending the patient has, during the last few years, been found so 
valuable as to have taken a permanent place in therapeutics. The 
method is not confined to cases depending upon diseases of the verte- 
brae producing lesions in the spinal cord, but is equally useful in 
instances where the lesion is primarily situated in the nervous centres. 
The pain, nervous shootings, aud tinglings, as well as the muscular 
contractions, which often trouble the patient very greatly, are all re- 
lieved, and in some cases walking is possible, where, before the treat- 
ment, crutches were entirely relied upon. The knee-jerk, when absent 
or excessive, tends to return to the normal state, and the bladder and 
rectum become more regular in their functions. 

The patient should use one of the apparatuses made by most large 
surgical instrument makers, which consists in a cushioned head-strap 
and a cushioned leather loop for each axilla. The traction on the 
head should not be sufficient to cause discomfort ; in other words, the 
weight of the patient should be equally distributed between the shoul- 
ders and the head. A rope is run from the harness to a pulley in the 
ceiling, and by this means the patient may be slightly raised from his 
chair — say, two inches — once a day, for thirty seconds at first, which 
may gradually be increased to ten minutes. The swinging should be 
resorted to at first every second and third and finally every day. If 
several pulleys are put in the circuit of rope, the patient can soon learn 
to lift himself, making the rope fast to a cleat in a heavy chair or 
table or even holding it in the hands. It is important that the patient 
after each swinging should rest for thirty minutes to an hour, and 
when let down to his chair the movement should be most gentle and 
not jerky or sudden. The same rule as to gentleness applies to raising 
the patient. 

TRANSFUSION. 

Very closely allied to the intravenous injection of medicines is the 
transfusion of saline liquids, blood, or detibrinated blood, for the pur- 
pose of replacing the vital fluid which may have been lost by haemor- 
rhage. It must be distinctly understood that transfusion is not to be 
resorted to in the presence of heart failure arising from other causes 
than haemorrhage, nor for the purpose of improving the state of the 



TRANSFUSION. 369 

blood in the vessels. Its effect is only temporary, and it is used solely 
for the purpose of bridging the chasm until the system can manufac- 
ture normal blood after a sudden loss. It has been found that the 
transfusion of pure blood even in the " direct method/' which will be 
presently described, is no better than the employment of a properly 
made saline fluid, because the corpuscles are killed by the change of 
abode, even from man to man, and their destruction gives the kidney 
the work of eliminating the free haemoglobin. 

Direct transfusion may be performed by the employment of a large 
number of complicated pieces of apparatus, but the simplest manner 
of procedure is as follows, provided a good-sized vein is used, and the 
blood-donor is full-blooded, as he ought to be : An incision is made 
in the arm of the donor over the longitudinal axis of the vein, gener- 
ally a prominent one on the flexor surface of the forearm or arm. As 
soon as the vessel has been cleanly dissected from the surrounding 
tissues, a bull-dog clip should be placed above and below the point 
where it is intended to make the incision in the vessel. At the same 
time a silk ligature is passed under the vessel. The vessel is now 
longitudinally incised, and a small glass or metal canula furnished 
with a shoulder is slipped into the opening, with its point toward the 
wrist, after which the ligature is tied so as to hold the canula in place. 
The opposite end of the canula should be attached to a short rubber 
tube of about eight inches in length, and the moment this is in place 
the canula and tube should be filled with a normal saline solution. 
(See below.) The same process is then repeated with the vein of the 
recipient, except that the canula is not armed with a rubber tube, and 
is pointed toward the body of the patient, or, in other words, in the 
direction of the blood stream. 

The only point where great care is to be exercised is in the filling 
up of the tubes with saline solution to displace the air. 1 The tubes 
being completely filled, the ends are joined by slipping the tube of the 
recipient into the rubber tube of the donor. The bull-dog clip next 
the shoulder of the recipient is now removed, and the one next the 
hand of the donor is taken off, thus allowing the blood to flow from 
one person to the other. It is necessary that the other clips should 
remain to prevent haemorrhage by anastomosis back of the canulas. 
If the pressure is low in the vein of the donor, the passage of the 
blood from the one to the other must be aided by stroking the tube 
in the direction of the flow, using enough compression to displace the 
fluid. If the tubing is elastic and strong, this method is fully as good 
as that of Aveling, where it is necessary to use a ball syringe to propel 
the blood and fill the tubes. The normal saline liquid, already named, 
consists in a solution of common salt of the strength of nearly 6 parts 
to the thousand, or, in other words, six-tenths of 1 per cent, or, in 

1 Whether or not small amounts of air finding entrance into the veins do any 
harm is not decided. A number of deaths in man from this cause are reported, but 
the experiments of Senn and of the author show that large amounts have to be in- 
troduced before death occurs. As the dread of such an accident is part of the medical 
teaching of the past, it is at least well to respect it, 

24 



370 REMEDIAL MEASURES OTHER THAN DRUGS. 

other words, 1J drachms of pure common salt to a quart of distilled 
water. It is called a normal solution because its percentage of saline 
is exactly that of the blood. 

The amount of blood transfused may be from 2 ounces up to the 
point at which its withdrawal causes the donor to feel faint, but 8 
ounces is generally the maximum amount used. It is to be remem- 
bered that the passage of the liquid must be gradual, not sudden, and 
that an excessive amount may cause cardiac distress. 

The use of defibrinated blood ought never to be resorted to when 
direct transfusion or a proper saline is to be had, as the difficulty in 
separating all the minute coaguli is very great, and it is also difficult 
to maintain the temperature. If direct transfusion is not wished for, 
the saline solution named may be gently forced into the vein by means 
of a good hydrostatic syringe raised very slightly above the level of 
the patient. The water used should always be boiled to render it 
aseptic. The solution used should, of course, be warm, at a temper- 
ature of about 100° or 101° F., and the presence of any foreign or 
insoluble substance must be strenuously guarded against. Indeed, it 
is always best to pass the liquid through a fine sieve before it is used. 
The quantity of saline used should not exceed one pint, and this is 
usually more than should be given unless the haemorrhage has been 
exceedingly severe and the patient really improved by the addition 
of each ounce of liquid. 

In a large number of cases warm fresh milk, just as it is drawn 
from the cow, has been used as an injection into a vein with success, 
but it always causes albuminuria, and is not as good as directly trans- 
fused blood, nor better than saline solutions unless it is taken directly 
from the udder of the cow as it is milked. The possibility of the 
cow being tuberculous is also to be remembered. 

Abdominal transfusion of both saline solutions and milk have been 
successfully carried out, the reason being that the peritoneal cavity is 
a vast absorbent surface which rapidly takes up liquids if the systemic 
vessels are not as full as they normally should be. The method con- 
sists in puncturing the abdominal wall as if for aspiration for dropsy. 
The tube from a hydrostatic syringe is now attached to the canula, 
and the liquid, having been warmed, is allowed to slowly flow into 
the belly. This method is not to be relied on where death seems very 
imminent, as it is not rapid enough in its effects. 



VENESECTION. 

Bleeding, or Phlebotomy, is so rarely practised to-day that very 
many of the profession have never abstracted blood for therapeutic pur- 
poses or have even seen it done by someone else. Furthermore, it is 
to be feared that many of the younger physicians would hardly know 
how to bleed if called upon to do so at a crisis. All this is wrong, 
for bleeding is a measure undoubtedly of the greatest value and one 
which everyone may be called upon to resort to. Like many medical 



VENESECTION. 371 

measures, it was sadly abused in the early part of this century, aud 
people were bled with the same regularity that they were put to bed. 

The indications for venesection are as clear and well defined as are 
the indications for any remedy. Briefly stated, we may say that all 
states of the circulatory apparatus denoting high arterial tension and 
excitement are indications, and that weakness, low arterial tension, and 
systemic or circulatory depression are contra-indications. Since the 
use of veratrum viride has become more common the conditions indi- 
cating venesection have been lost sight of, because this drug so dilates 
the blood-paths that a man is bled into his own vessels. 

Having made clear the general indications for the use of venesec- 
tion, we may pass on to state some of the diseases in which it may be 
well resorted to. Of these, pneumonia, pleurisy, meningitis, and peri- 
tonitis, if they are sthenic, are typical examples, since all of them are 
accompanied by arterial excitement and characterized by local conges- 
tions affecting the lung, pleura, cerebral membranes, or peritoneum. 
(See Pneumonia.) By the abstraction of blood the vascular tension 
is lowered and the engorged area relieved. In the first place, the con- 
gested area is made up of relaxed bloodvessels, whereas the remaining 
bloodvessels of the body are tense, and, as a consequence, the blood is 
urged to the spot already engorged. In the second place, the abstrac- 
tion of blood from the tense bloodvessels renders the general pressure 
lower than that in the diseased area, and the congestion is relieved. 

In apoplexy the extravasation of blood into the brain causes great 
arterial excitement, as a general rule, and this in turn results in in- 
creased intracranial haemorrhage. Bleeding is, therefore, strongly 
indicated, not only to prevent inflammation, but also to prevent further 
leakage into the brain substance. 

The method by which venesection is practised is yet to be described. 
It is a very simple operation if an assistant is present to make 
pressure on the vein or entire arm. Often this pressure is best exer- 
cised by means of a handkerchief or bandage tightly twisted about 
the arm above the spot where the incision is to be made. Under these 
circumstances, the veins of the arm become prominent and distended, 
and one of them may be readily bared by a short longitudinal incision 
of half an inch, the fascia being separated until the glistening blue 
surface of the vessel appears, free from fat or connective tissue. Into 
this vessel, with the edge of the knife turned upward, a small longi- 
tudinal incision is made, care being taken that the point of the blade 
is not driven in far enough to injure the posterior wall of the vein. 
If a clot forms and stops the flow it must be removed by an aseptic 
cloth, while if the flow is to be stopped we may remove the bandage 
above and apply a compress over the incised vein, which compress, 
may be held in position by a bandage. 



FOODS FOR THE SICK. 



PEPTONIZED MILK. 

Take a perfectly clean, clear glass quart bottle and place iu it the 
contents of one of Fairchild Bros.' peptonizing tubes or Parke, Davis 
& Co.'s peptonizing tablets, both that containing the sodium and that 
containing the pancreatin, and a teacupful of cold water, and after 
shaking pour into the bottle a pint of perfectly fresh, cool milk and 
stir the mixture thoroughly. Next place the bottle containing the 
milk in a can of water at such a temperature that the whole hand of 
the nurse may be indefinitely submerged in it without pain. If com- 
plete digestion of the milk is desired, this application of heat may be 
continued as long as twenty minutes, but in most cases five minutes 
is sufficient. If carried on longer than twenty minutes, the milk will 
become bitter and disagreeable to the taste through the development 
of peptone in excess. 

Immediately after taking the bottle from the hot water it should 
be placed on ice, in order to check further peptonizing and to keep 
the milk from spoiling ; or if ice is not available the water bath 
should be quickly brought to a boil, in order to prevent further action 
of the ferment, and the bottle then be placed in a cool place. This 
recipe may be used where it is thought necessary to digest the milk 
before it is swallowed. Where we desire simply to aid digestion it 
is best to follow the directions already given, except that the bottle 
is not heated but at once placed upon ice and allowed to remain 
there, being slightly warmed when it is desired to give it to a child, 
or it may be given as a cool and refreshing drink to an adult, the 
heat of the body rapidly causing the ferment to do its work as soon 
as the food enters the stomach. When irritability of the stomach 
exists in adults this peptonized milk may be made more agreeable to 
the taste by following the directions given in the first recipe, except 
that it must remain in the hot water for no less than two hours, when 
it is poured out into a tin cup or pan and rapidly brought to the 
boiling-point. After this it is strained through a piece of coarse 
muslin and placed upon ice. Before giving it to a patient this mix- 
ture may be flavored with lemon or orange juice or any form of acid 
that is desired, without the milk becoming curdled. Peptonized milk 
punch is made from milk prepared in the way already described in 
the first recipe, by adding St. Croix or Jamaica rum or brandy, 
and is a pleasant nutrient, particularly if the surface of the liquid is 
sprinkled with a little grated nutmeg. 



PEPTONIZED GRUEL. 373 

A very refreshing and agreeable drink may be made be diluting 
peptonized milk one-half with highly charged carbonic acid water and 
swallowing it while effervescing. 



PEPTONIZED BEEP. 

The following method of preparing Peptonized Beef is recommended 
by the Fairchilds, and is very useful, as is also peptonized oyster stew 
as first introduced by my friend, the late Dr. N. A. Eandolph. 

Take J pound of finely rninced raw lean beef; cold water, \ pint. 
Mix in a saucepan. Cook over a gentle fire, stirring constantly until 
it has boiled a few minutes. Then pour off the liquor for future use, 
beat or rub the meat to a paste, and put it into a clean fruit jar with 
\ pint of cold water and the liquor poured from the meat, and add 

Extracti pancreatis (Fairchild) . . .20 grains. 
Sodii bicarb 15 " 

Shake well together, and set aside in a warm place, at about 110° 
to 115°, for three hours, stirring or shaking occasionally ; then boil 
quickly. The liquid may then be strained, or clarified with white of 
egg in the usual manner, and seasoned to taste with salt and pepper. 

In the great majority of cases it is not necessary to strain the 
peptonized liquor, for the portion of meat remaining undissolved will 
have been so softened and acted upon by the pancreatic extract that 
it will be in very fine particles and diffused in an almost impalpable 
condition, and is, therefore, in a form ready for asssimilation in the 
body. 

Peptonized Oysters. — Peptonized Oysters are prepared by mincing 6 
to 12 large oysters, and adding to them, when mixed with a moderate 
amount of their own liquid, 5 grains of pancreatin or peptonizing 
powder and 20 grains of sodium bicarbonate. The cup containing 
this mixture is now placed in warm water at 100° P. and allowed to 
remain there from ten to twenty minutes, according to the degree of 
digestion desired. After this the liquid mass is quickly brought to a 
boil to cook the oysters and stop digestion, and served with pepper 
and salt as required. Any condiment or flavoring substance may be 
used. 

PEPTONIZED GRUEL. 

Peptonized Gruel may be made by taking thoroughly boiled hot 
gruel made from oatmeal, barley, wheat, or from arrow-root, to the 
amount of J pint, and adding thereto while it is hot, J pint of fresh, 
cold milk ; to this may now be added the contents of one peptonizing 
tube and the mixture allowed to stand in moderately hot water or in 
a warm place for twenty minutes before it is placed upon ice. 



374 FOODS FOR THE SICK. 



KOUMYSS. 

This is a preparation of milk which is very useful for children and 
adults during convalescence from acute or subacute exhausting dis- 
eases. Even young children of three or four years will take a fancy 
to it if it is not made too sour by continuing the fermentation process 
too long. The liquid is prepared as follows : Add to 1 pint of cool, 
perfectly fresh milk 2 teaspoonfuls of sugar, and place it, after shak- 
ing thoroughly, in a beer or claret bottle. Then add ^ of a cake of 
Fleischman's compressed Vienna yeast and tightly cork the bottle, 
standing it in a warm place or in a water-bath at 99° to 100° F. for 
eight to ten hours. Then place in a cool place or on ice and use as 
needed. It must be remembered that the development of carbonic gas 
is very great in this liquid, and that if an ordinary cork is inserted it 
must be tied in before the heat is applied. Further than this, the 
cork must be pulled very gently or the liquid will squirt all over the 
room. The best thing to use when about to drink the koumyss is 
a " champagne tap," by means of which the liquid may be drawn off 
as needed. 

DIET LIST. 

The following bills of fare are used in the Children's Hospital in 
this city, with good results, are easily prepared, and the directions 
readily carried out by the inexperienced : 

Diet in Gr astro-intestinal Catarrh for a Child of Seven Years. 

Breakfast, 7.30 a.m. : Milk, with lime-water ; 4 teaspoonfuls of 
lime-water to each tumblerful of milk. The lightly-boiled yelks of 
two eggs, thin slices of well-toasted bread, or stale bread. 

Dinner, 12 M. : A mutton chop without fat, broiled, or a slice of 
roast beef or mutton, occasionally a bowl of meat broth. Stale bread 
or toast. 

Supper, 7 p.m. : Milk and lime-water. Stale bread or toast, or 
milk-toast. 

For drink : Filtered or boiled water. 

Starch foods to be avoided as much as possible. 

Diet for a Child Two Years Old. 

Breakfast, 7.30 A.M. : Milk. The lightly boiled yelk of an egg. 
Thin bread and butter (the bread to be one day old). 

Lunch, 11 a.m. : Milk. A thin slice of bread and butter. 

Dinner, 1.30 p.m. : Beef-tea or small piece of minced roast beef or 
mutton devoid of gristle. One well-mashed potato, moistened with 
gravy. Rice and milk. 

Supper, 6 p.m. : Milk. Bread and butter. 

For drink : Boiled or filtered water. 



KESTORATIVE BEEF ESSENCE. 375 

Diet for a Child One Year Old. (5 meals a day.) 

First meal, 7 a.m. : Two teaspoonfuls of grated flour-ball (prepared 
as directed below) in half a pint of milk. 

Second meal, 10.30 a.m. : Half a pint of milk with 4 tablespoon- 
fuls of lime-water. 

Third meal, 2 p.m. : The yelk of 1 egg beaten up in 1 teacupful of 
milk. 

Fourth meal, 5.30 p.m. : Same as the first. 

Fifth meal, 11 p.m. : Same as the second. 

Flour-ball is to be made by taking one pound of good flour — un- 
bolted, if possible — tie it up very tightly in a pudding bag ; put it in a 
pot of boiling water early in the morning, and let it boil until bed- 
time, then take it out and let it dry. In the morning peel off the 
surface, and throw away the thin rind of dough, and with a grater 
grate down the hard, dry mass into a powder. To use this, take from 
1 to 2 teaspoonfuls of the powder, rub it down until smooth with a 
tablespoonful of cold milk, and add 1 tumblerful of hot milk, stirring 
it well all the time. 

Diet for a Child from Six to Twelve Months Old. (5 meals a day.) 

First meal, 7 a.m. : Mellin's food, 1 tablespoonful, or flour-ball 
grated, 1 or 2 teaspoonfuls (prepared as directed above), hot water, 4 
tablespoonfuls ; warm milk, enough to make half a pint. Dissolve 
the Mellin's food or rub down the grated flour-ball in the hot water 
by stirring, then add the milk ; mix thoroughly. 

Second meal, 10.30 a.m., and third meal, 2 p.m. : A breakfast- 
cupful of milk with 4 tablespoonfuls of lime-water. 

Fourth meal, 5.30 p.m. : Same as first. 

Fifth meal, 10.30 p.m. : Same as second. 



BEEF TEA. 

Take 1 pound of lean beef, and mince it. Put it, with its juice, 
into an earthen vessel containing a pint of tepid water, and let the 
whole stand for one hour; strain well, squeezing all the juice from 
the meat. Place on the fire, and slowly raise just to the boiling-point, 
stirring it briskly all the time. Season with salt and pepper to taste. 
In administering this, always be careful to stir up the sediment. 

Or, take 2 pounds of beef, without fat or bone, half a breakfast- 
cupful of cold water ; place it in a jar in a saucepan of water. Sim- 
mer four hours. 



RESTORATIVE BEEF ESSENCE. (Ringer.) 

Take 1 pound of fresh beef, free from fat, chop it up fine, and 
pour over it 8 ounces of soft water, add 5 or 6 drops of hydro- 



376 FOODS FOR THE SICK. 

chloric acid, and 50 or 60 grains of common salt, stir it well, and 
leave it for three hours in a cool place. Then pass the fluid through 
a hair sieve, pressing the meat slightly, and adding gradually toward 
the end of the straining about two ounces more of water. The liquid 
thus obtained is of a red color, possessing the taste of soup. It 
should be taken cold, a teacupful at a time. If preferred warm, it 
must not be put on the fire, but heated in a covered vessel placed in 
hot water. 

Should it be undesirable for the patient to take the acid, this soup 
may be made by merely soaking the minced beef in distilled water ; 
or, take 1 pound of gravy beef, free from fat and skin, chop it up 
very fine, add a little salt, and put it into an earthen jar with a lid, 
such as is used for roasting venison, fasten up the edges with a 
thick paste, and place the jar in the oven for three or four hours. 
Strain through a coarse sieve, and give the patient two or three 
teaspoonfuls at a time ; or, cut up in small pieces 1 pound of lean 
beef from the sirloin or rump, and place it in a covered saucepan, 
with J pint of cold water, by the side of the fire for four or five 
hours, then allow it to simmer gently for two hours, skim it well, 
and serve. 

BARLEY WATER. 

To prepare barley water, put two good-sized teaspoonfuls of washed 
pearl barley with 1 pint of cold water in a saucepan, and boil slowly 
down to two-thirds. Strain. 



RICE WATER. 

Rice water is made by boiling 2 ounces of clean rice in 2 quarts 
of water for an hour and a half. 



WINE WHEY. 

Boil 1 pint of fresh milk ; while boiling, pour in 1 small tumbler- 
ful of sherry wine (8 tablespoonfuls), bring it to the boil a second 
time, being careful not to stir it ; as soon as it boils set it aside until 
the curd settles, and pour off the clear whey. 



ALMOND BREAD FOR DIABETICS. 

Take of blanched sweet almonds J pound, beat them as fine as pos- 
sible in a stone mortar ; remove the sugar contained in this meal by 
putting it into a linen bag and steeping it for a quarter of an hour in 
boiling water acidulated with vinegar ; mix this paste thoroughly 
with 3 ounces of butter and 2 eggs. Next add the yelks of 3 eggs 



MULLED WINE. 377 

and a little salt, and stir well for some time. Whip up the whites of 
3 eggs and stir in. Put the dough thus obtained into greased moulds, 
and dry by a slow fire. 



BRAN BREAD FOR DIABETICS. 

Take a sufficient quantity (say 1 quart) of wheat bran ; boil it in 
two successive waters for a quarter of an hour, each time straining it 
through a sieve ; then wash it well with cold water (on the sieve) 
until the water runs off perfectly clear ; squeeze the bran in a cloth 
as dry as you can, then spread it thinly on a dish and place it in a 
slow oven ; if put in at night, let it remain until morning, when, if 
perfectly dry and crisp, it will be fit for grinding. The bran thus 
prepared must be ground in a fine mill and sifted through a wire 
sieve of such fineness as to require the use of a brush to pass it 
through ; that which remains in the sieve must be ground again until 
it becomes quite soft and fine. Take of this bran powder 3 ounces 
(some patients use 4 ounces). The other ingredients as follows: 3 
new-laid eggs, 1J ounces (or 2 ounces, if desired) of butter, and about 
\ pint of milk ; mix the eggs with a little of the milk, and warm the 
butter with the other portion ; then stir the whole well together, add- 
ing a little nutmeg and ginger, or any other agreeable spice. Bake 
in small tins (patty-pans), which must be well buttered, in a rather 
quick oven for about half an hour. The cakes, when baked, should 
be a little thicker than a ship's biscuit ; they may be eaten with meat 
or cheese, at breakfast, dinner, and supper ; at tea they require rather 
a free allowance of butter or they may be eaten with curd or any of 
the soft cheeses. 

" It is important that the above directions as to washing and drying 
the bran should be exactly followed, in order that it may be freed from 
starch and rendered more friable. The bran in its common state is 
soft, and not easily reduced to fine powder. In some seasons of the 
year, or if the cake has not been well prepared, it changes more 
rapidly than is convenient, owing to moisture. This may be prevented 
by placing the cake before the fire for five or ten minutes every day." 



MULLED WINE. 

Boil some spices, cloves, nutmeg, cinnamon, or mace, in a little 
water, and add as much of this decoction as is necessary to flavor a 
wineglassful of sherry, or any other wine. Add sugar to taste, and 
bring the mixture to the boiling-point. If claret is used, it will require 
more sugar than if a less sour wine is employed. The vessel for 
heating the wine should be scrupulously clean. 



378 FOODS FOR THE SICK, 



WATERED TOAST. 

Brown several pieces of bread and carefully butter the toast so that 
the butter is equally distributed. Place enough salt over the toast to 
flavor it and add pepper to taste. Finally pour as much boiling 
water on the edges of the crust as is necessary to thoroughly soak 
them, and serve to the patient. This is a more agreeable dish than 
would be imagined, and is useful where milk toast is distasteful. 



PART IV. 

DISEASES. 



ABORTION. 

The treatment of- abortion divides itself into three parts : the first 
for its prevention, the second for its arrest when threatened, the third 
for its proper care when inevitable. 

In the preventive means we find, as in nearly every branch of 
medicine, that the use of hygienic measures is more important than 
the employment of drugs. If the previous abortions are known to be 
due to syphilis, endometritis, or uterine displacements these conditions 
must be relieved by the proper remedies. If there exists no apparent 
cause for the interruption of normal gestation, the patient should use 
a simple diet, lead a quiet life, avoid all sexual intercourse, sleep on a 
hard bed, and resort only to gentle exercise. Fresh air is, however, a 
necessity and should be plentifully supplied. The food should be 
light, but nutritious and palatable, and a sufficient variety supplied to 
avoid any repugnance to a given dish. In many cases abortion rests 
upon deficient nutrition of the foetus, either by reason of faulty assim- 
ilation on the part of the mother or because of poor food, so that if 
anaemia, debility, or other impoverished states of the maternal system 
be present, these should be treated at once. The clothing should be 
loose, the night's sleep undisturbed and of full length, and the mind 
be set at rest as far as possible in respect to household and other 
worries, and particularly diverted from the thought of possible uterine 
disturbance. 

The use of drugs is to be limited strictly to the fulfilment of a dis- 
tinct indication, and the employment of cathartics is to be avoided, the 
bowels being kept in order by fresh fruits in moderate quantity, or by 
mild laxatives, such as cascara sagrada in small doses and compound 
liquorice powder. If these fail rhubarb may be resorted to and castor 
oil in capsule may be used. Podophyllin, senna in full doses, saline 
purges in active amounts, and aloes, are not to be used if they can be 
avoided. If the woman be exceedingly stout and plethoric saline 
purges are indicated to act as depletants. It is hardly necessary to 
add that elaterium and scammony, or jalap, are not safe, and can only 
be used if dropsy and ascites are present and where we must choose 
the least of two evils. Strychnine, which stimulates the spinal cord, 
should never be employed, and cautharides, oil of erigeron, and 



380 DISEASES. 

manganese ought not to be used unless they are for some reason very 
necessary. Although quinine is not of itself abortifacient, it is unsafe 
if an abortive tendency is present, and can only be used in cases in 
which the abortion is brought on by malarial poisoning, when it will 
act as a preventive. 

The only drug which seems to be of any service as a prophylactic 
to be taken all through pregnancy is the fluid extract of viburnum 
prunifolium, the dose of which is f to 1 drachm. This drug is said to 
be a uterine sedative and to have no injurious effects upon the mother 
or child. 

Cimicifuga racemosa is probably equally valuable as a prophylactic 
against abortion in the dose of 10 to 20 drops of a good sample of the 
fluid extract, given night and morning. 

The arrest of threatened abortion is one of the most difficult duties 
which come to the physician, and there is no doubt that large doses of 
morphine or opium are the best means of quieting the uterus that we 
have. While viburnum prunifolium may be resorted to, we do not 
know enough of it to rest assured of its value, but it should be tried 
if opium is not at hand or fails. The patient should be at once quietly 
placed in bed in the most comfortable position, be so covered as to 
prevent over-heating and taking cold, and receive by the hypodermic 
needle J grain of morphine, or better still, a rectal injection of warm 
starch-water containing 30 drops of laudanum. The bulk of the 
injection should be small in order not to disturb the bowels, and must 
be at the bodily temperature. If this is not done, a suppository of 
the aqueous extract of opium, containing J to J grain, should be used. 
Ice-cold drinks should be given and no tea or coffee allowed. This 
treatment quiets the uterus, allays nervousness and restlessness, and at 
least puts off the abortion for a few hours. Venesection has been 
practised in very plethoric women with advantage. 

When an abortion is inevitable it is to be treated by measures directed 
to the avoidance of haemorrhages, the thorough delivery of the ovum 
and its appendages, and the prevention of inflammation and septi- 
caemia. For the prevention of haemorrhage a number of balls of 
absorbent cotton tightly wound with thread to the size of a small egg 
should be packed into the vagina back of and around the cervix until 
the bleeding is controlled, and while a small amount of iodoform may 
be dusted over them before they are inserted, no astringents are to be 
applied, unless it be tannic acid to coagulate the blood in the cotton, 
as astringents cannot reach the bleeding-spot. Sponges ought never to 
be used, as they often fail to control the bleeding and rapidly become 
septic. By means of this packing the blood in the uterus cannot 
escape, and, as the uterine walls contract, they urge the liquid between 
the membranes, thereby causing complete separation. Ergot should 
be used after the tampons are applied in the dose of a fluid rachm of 
the extract or a tablespoonful or two of the wine. Generally after 
twenty-four hours the removal of the tarrfpons will show the ovum to 
be in the vagina, but if part of it remains in the uterus the following 
measures should be resorted to. The administration of ergot should 



ABSCESS. 381 

be stopped unless the haemorrhages are severe, and the uterine cavity 
is to be cleared by the use of the fingers of the attendant, who grasps 
the membranes and draws them away. If the cervical canal is too 
small it must be dilated by dilators or by packing it with sponge 
tents. After the membranes are removed the tincture of iodine 
should be applied to the inner surface of the uterus as a haemostatic, 
antiseptic, and alterative. 

The after-treatment consists in the use of small doses of ergot and 
quinine, of vaginal antiseptic irrigation or even of uterine irrigation 
if it is needed, and the maintenance of perfect rest for one or two 
weeks, or longer if possible. Ergot ought not to be given if there is 
reason to believe that portions of the membranes or blood-clots are in 
the uterus, as by contraction of the os uteri it may imprison materials 
which may become septic. (See Puerperal Diseases.) 



ABSCESS. 

The medical treatment of abscess resolves itself into the use of 
drugs to prevent the formation of pus, to cause its fatty degeneration 
and absorption, to quiet the systemic disturbance if the inflammation 
be severe, and to support the body if the suppuration be prolonged, 
or in large amount, or if debility exists. The treatment may also be 
divided into that suited to acute and to chronic abscess. 

As acute abscess in its early stages is simply a localized inflamma- 
tion with hypersemia and an outpouring of leucocytes, it may often 
be aborted by the use of aconite or veratrum viride in full dose to 
quiet the circulatory excitement and relieve the congestion. This is 
particularly true where the pain is pulsating. At the same time, if 
the swelling is superficial, a poultice, made by moistening bread- 
crumbs 'with lead-water, should be placed over it, or lead- water may 
be placed on lint and applied in this way. Belladonna ointment 
smeared over the same area may be of service, and the tincture may 
be used internally if aconite cannot be had. If a gland be involved 
the needle of a hypodermic syringe may be inserted obliquely into 
its centre and 5 to 10 minims of a 2 per cent, solution of carbolic 
acid injected into the swelling. This method has been found of 
singular efficacy in bubo where pus seemed just about to form. It is 
almost always curative., but should not be used in a stronger or weaker 
solution than that named. Another useful abortive method for the 
treatment of the early stages of abscess is the application, externally, 
of a strong solution of nitrate of silver, 20 to 40 grains to 1 ounce 
of water, by means of a camel's-hair brush, all over the skin, cover- 
ing the area involved, or by the use of the tincture of iodine in a 
similar manner. 

Internally, calx sulphurata in the dose of -^ grain given every 
hour or two, may be used as an abortive, or at least to promote arrest 
and cause absorption. If it becomes evident that pus is going to 
form, then resort must be had to poultices which by their heat and 



382 DISEASES. 

moisture will aid in the formation of pus by favoring the escape of 
leucocytes and by softening the tissues. If pus forms and fluctuation 
ensues the abscess should be freely opened, drained, washed out by a 
solution of carbolic acid, in the strength of 1 to 20, or of bichloride 
solution 1 to 5000, and dressed with antiseptic gauze. If it is tuber- 
cular the abscess may be opened in the ordinary manner, all diseased 
tissues removed by scraping and the cavity packed with iodoform 
gauze, or it should be drained by aspiration and an ethereal solution 
of iodoform injected and allowed to remain in the abscess cavity if it 
is a small one. The opening is now closed by a pledget of cotton 
wet with tincture of benzoin and an antiseptic dressing applied over it. 
Not more than 20 grains of iodoform should be so used in the treat- 
ment of tubercular abscess. 

A very good treatment for slow abscess is to wash out the cavity 
with a 10 per cent, solution of peroxide of hydrogen. 

If the abscess is chronic (cold abscess) and associated with great 
weakness, resort must be had to the internal use of iron in the form of 
the tincture of the chloride, cod-liver oil, with hypophosphites, quinine 
as a tonic to prevent hectic fever, and the use of nutritious, easily di- 
gested food. Alcohol may be used and should be given with the milk. 

The following tonic pill and solution are of service : 

H. — Strychninse sulph . . . . . . gr. j. 

Ferri redact. . . . . . . gr. xv. 

Quininse sulph. ...... gr. xx. M. 

Ft. in pil no. xx. S. — One t. d. after meals. 

Or, 

R . — Tr. cinchona? comp ~\ 

Tr. gentian, comp. j- . . . . aa fSjiij. 
Tr. cardamom, comp. J M. 

S. — Dessertspoonful t. d. after meals. 

Having described the means of treatment, it is to be explained how 
these measures act. The aconite quiets the circulation and thereby 
relieves the inflammation, the lead-water acts locally as an astringent 
and sedative, while the belladonna by its action on the bloodvessels 
contracts the dilated capillaries and allays pain. When carbolic acid 
is injected into an enlarged gland it acts as an anaesthetic, as an 
antiseptic to the germs always present, such as staphylococci, and as 
an astringent and stimulant. The nitrate of silver applications act 
by con stringing the bloodvessels, as local sedatives and as counter- 
irritants. The iodine applications do likewise, and also exercise an 
alterative influence. 

The physiological action of calx sulphurata is unknown. The 
object in using the antiseptic irrigations is self-evident and the em- 
ployment of iodoform in tubercular abscess rests upon the studies of 
Bruns, of Tubingen, and many others, who have found by experi- 
ment that iodoform is fatal to the bacillus tuberculosis. 

As large numbers of corpuscles are destroyed in the formation of 
pus, and other sources of vitality are sapped by its formation, the use 



ADENITIS. 383 

of hypophosphites and iron to replace the loss is necessary, and of 
cod-liver oil and tonics to increase the blood-corpuscles and the assimi- 
lation of food. 

ACNE. 

This affection occurs in so many forms and arises from such differ- 
ent causes that a thorough consideration of its treatment cannot be 
here given ; suffice it to state that arsenic is a remedy which will often 
cause a cure and prevent a relapse if used in small doses for a long 
period — that is : 1 to 3 drops of Fowler's Solution three times a day 
for a month or two. This is particularly useful if debility and anaemia 
underlie the disease. If the anaemia be marked, the proper treatment 
is that directed to the cure of this condition (see Anaemia) ; if obstinate 
constipation is present, relief must be obtained by saline purges and 
the bowels kept in order by cascara sagrada or some similar drug. If 
scrofulosis exists cod-liver oil is of great service, or, if much pustula- 
tion is present, calx sulphurata, in the dose of -^ to J of a grain, may 
be used in pill form three times a day. In menstrual acne sulphur 
may be used internally to open the bowels, and applied as a wash to 
the face in the following form : 

I£. — Sulphuris 3j. 

Glycerini f.^j. 

Aquse rosse . . . . . q. s. ad fjfviij. M. 
S. — Apply twice or thrice a day. 

Or the following may be used in cases of severe inflamed acne : 

fy. — Sulphuris iodidi gr. xxx. 

Cerati simplicis . . . . . §j. M. 

S. — Apply to the parts night and morning. 

If the skin is very atonic, muddy, and torpid, it should be bathed 
night and morning with hot water and castile soap, or even with the 
tincture of green soap, and well rubbed with a rough towel. 

If the green soap causes irritation, some bland application should 
follow it, such as simple cerate or the emulsion of the oil of bitter 
almonds. If the pustules be large they may be incised and vent given 
to their contents, the sac being touched with a drop of carbolic acid. 
If induration is great, ichthyol ointment of the strength of 20 parts of 
ichthyol to 100 of lard should be well rubbed in, or resorcin, 10 to 20 
grains to the ounce of lard, be applied. Mercurial ointment may also 
be used to relieve induration, but several days must elapse between its 
use and that of sulphur, as a black sulphuret of mercury may be 
formed and stain the face. 

ADENITIS. 

Adenitis is an inflammation of the lymphatic glands, generally 
arising from scrofulosis, unless there be some specific trouble, such as 
syphilis, present. Less commonly it occurs in the neck from the irri- 



384 DISEASES. 

tation produced by the eruption of milk-teeth, sometimes from blows 
or exposure to cold. 

If the condition consists in a simple enlargement it should be treated 
by inunctions of iodine ointment and lard, half and half, night and 
morning, care being taken that the ointment is stopped as soon as any 
reddening of the skin appears, or if fluctuation develops. If the oint- 
ment cannot be used, the tincture of iodine should be thoroughly 
painted over the swelling with a brush, but is less efficacious. The 
following prescription makes a useful application : 

R. — Ichthyol giv. 

Adipis benzoinat gij. M. 

S. — Rub a small piece of the ointment into the swelling, t. d. 

Syrup of the iodide of iron, in the dose of 5 to 10 drops, is to be 
given if tbe patient is a child, and tonics must be used to improve the 
systemic condition. As soon as fluctuation or reddening shows the 
formation of pus all this treatment should be stopped, and a poultice 
be applied for twenty-four or forty-eight hours till the swelling goes 
down or is ready for lancing. Lancing is better than allowing the 
abscess to break, as the scar left in after years is a mere line instead of 
a large cicatrix. 

If the enlargement be scrofulous, the following treatment, recom- 
mended by Treves and Griinfeld, is of value, and should be carried 
out if the patient will submit to it : 

The entire removal of the glands should be effected by dissection 
alone ; directors, handles of scalpels, or fingers should be used to sepa- 
rate the glands from the surrounding cellular tissue as closely from the 
capsule as a nerve is cleaued in the dissecting-room. When sufficient 
of the anterior surface is exposed, a thick thread is passed through the 
gland, and drawn gently, when by continuing the dissection the opera- 
tor may gradually get to the back of the gland, removing portions of 
the mass at a time. The cavity should be packed with iodoform gauze, 
and the walls scraped if an abscess has existed. 



ALCOHOLISM. 

(See Alcohol.) 

ALOPECIA. 

This disease, when due to a parasite, is best treated, according to 
Crocker, by first pulling out all the loose hairs around the bald spot 
and then painting the affected surface with linimentum cantharidis 
(liquor epispasticus). Three coats of this liquid should be employed, 
and each coat allowed to dry before the next is applied. In other 
cases an ointment of chrysarobin, J to 1 drachm to the ounce of lano- 
lin, may be used, but care must be exercised that too much staining of 
the skin and clothes does not result. Another equally good applica- 



AMBLYOPIA AND AMAUROSIS. 385 

tion is 2 grains of mercury bichloride to 1 drachm of rectified spirit 
and 7 drachms of oil of turpentine. This mixture may be rubbed in 
with the finger over and around the patch. If the patient's skin will 
stand it, 5 grains of the corrosive sublimate may be used in place of 2 
grains. 

AMBLYOPIA AND AMAUROSIS. 

Amblyopia, or dull vision, and amaurosis, or blindness, usually 
refer to defective sight or its total loss, the result of functional dis- 
turbance of the retina, optic nerve, or visual centres, and unaccom- 
panied by changes in the eye-grounds in the beginning of the disease. 
These terms, however, also include cases of partial or complete blind- 
ness, in which optic atrophy subsequently develops, and are often used 
to describe ocular disorders not limited by the definitions here em- 
ployed. 

These cases may be gathered into certain groups : 

I. Congenital amblyopias and amblyopias from non-use of the 
eyes. 

In the former there is often a high degree of error of refraction, 
usually far-sightedness ; the latter is seen when an eye is debarred 
from binocular vision by a squint. In both the treatment consists in 
as perfect a correction of the optical error as possible, and, in case one 
eye alone is involved, the separate exercise of its functions. Con- 
genital amblyopias may include incurable defects in the structure of 
an eye. 

II. Amblyopias the result of (a) general diseases or conditions — 
typhoid fever, the exanthemata, syphilis, scurvy, malaria, colds, etc.; 
(b) local diseases or conditions — haemorrhoids, haemorrhage, pregnancy, 
disordered menstruation, kidney disease, diabetes, migraine, disorders 
of the nervous system, etc. 

The remedies indicated by the special cause are to be employed ; 
the medicinal agents most usually needed being mercury, iodide of 
potassium, pilocarpine, particularly in uraemic amaurosis, emmena- 
gogues, and tonics, especially hypodermics of strychnine. As local 
measures repeated fly-blisters to the temples, wet and dry cups, and 
the constant electric current are used. The nape of the neck may be 
cauterized or a seton introduced. In hysterical cases metallotherapy 
may be tried. 

III. Amblyopias the result of the action of certain medicinal and 
toxic agents. 

The abuse of alcohol, and particularly of tobacco, produces a form 
of amblyopia characterized by the development of a scotoma or an 
area in the centre of the field of vision, in which the appreciation of 
red and green is lost or greatly diminished. Quinine in excess has, 
in a number of instances, been followed by temporary blindness, 
which is usually denominated quinine amaurosis. Of less frequent 
occurrence are the cases of amblyopia produced by the toxic action of 
salicylic acid, lead, silver, mercury, osmic acid, nitro-benzol, and the 



386 DISEASES. 

vapor of sulphide of carbon. In all instances the patient must be 
withdrawn from the influence of the poison ; in tobacco amblyopia, in 
its early stages, this is usually sufficient to effect a cure. The reme- 
dies which have proven of the greatest utility are digitalis, inhalations 
of nitrite of amyl, nitro-glycerin, and strychnine. Iodide of potas- 
sium should be exhibited in chronic cases, and always in amblyopias 
the result of lead-posoning. The constant current has also been em- 
ployed. 

IV. Amblyopias the result of direct or indirect injury, or from re- 
ilex irritations. 

Traumatic amblyopias may follow a blow upon the eye itself, or an 
injury to the skull or spinal cord. To carious teeth, intestinal irrita- 
tions, the presence of parasites, and the like, a certain number of am- 
blyopias have been attributed, but, while it is not possible to disprove 
the association, such cases must be received with doubt. After the 
removal of the cause, strychnine should be exhibited. 

Optic neuritis most frequently depends upon coarse diseases of the 
brain (tumor, abscess) or inflammation of its membranes (meningitis). 
It is also a symptom of numerous disorders — suppression of the 
menses, exposure to cold, rheumatism, anaemia, syphilis, uraemia, lead- 
poisoning, etc. The remedies are those naturally suggested by the 
disease or condition which has called it into existence. The prog- 
nosis depends upon the cause. Mercury, iodide and bromide of 
potassium, the salicylates, pilocarpine, local blood-letting and fly 
blisters, are the remedies commonly employed. 

Optic-nerve atrophy is either primary, or secondary to disease of the 
brain or spinal cord, or consecutive to an antecedent neuritis. After 
all irritation has subsided the greatest improvement may be expected 
from hypodermic injections of strychnine, which should be pushed to 
the point of tolerance. Temporary improvement follows the inhala- 
tion of nitrite of amyl, and, in the hope of improving the circulation 
in the optic nerve, digitalis and similar cardiac tonics may be em- 
ployed. The constant electric current has been employed with benefit. 



AMENORRHEA. 

This condition depends upon so many causes for its existence that 
it must be treated in many different ways. If anaemia or chlorosis 
show that a deficient supply of blood is present, measures adapted to 
the relief of such states are required (see Anaemia), while if plethora is 
a cause depletants in the shape of saline purges are needed, but aloes 
are harmful. In a similar manner, in amenorrhoea due to constipa- 
tion saline and other purges may be used, but the best of these is 
aloes ; and as constipation and anaemia often exist hand in hand, a 
combination of aloes and iron in a pill is commonly resorted to. 
The iron improves the blood, and the aloes stimulates and congests 
the pelvic viscera by bringing blood to the sexual organs. Aloes 
also increases the assimilation of iron in some unknown manner. The 



ANAEMIA. 3&i 

following pill is often of service and is especially recommended by 
Goodell : 

R. — Extract, aloes aqueosi ..... gj. 

Ferri sulphat. exsiccat ^ij. 

Asafcetidse ^iv. M. 

Ft. in pil. no. c. S. — From 1 to 3 pills three times a day. 

Cimicifuga has been highly recommended in chronic and apparently 
causeless amenorrhoea, in the dose of 30 drops of the fluid extract at 
the time for a proper flow to occur. Within the last few years the 
binoxide of manganese in the dose of 1 to 3 grains has come promi- 
nently forward as a remedy in simple idiopathic amenorrhoea and is 
undoubtedly of service, but it should be taken for at least two weeks 
before the date upon which each menstruation is expected to occur. 
Potassium permanganate is also useful duriug the same period in 
similar states, but it is inferior to the binoxide of manganese in the 
author's experience. 

Apiol, the active principle of parsley, may be given in capsules in 
the dose of 3 to 10 grains for the same condition, and oil of rue, 
savine, and tansy have also been employed in capsule in the dose of 
5 drops three times a day. 

In all forms of amenorrhoea a hot sitz-bath at the time for the 
expected " period " is of service, more particularly if the patient has 
" caught cold." The bath should be persevered in for several nights 
and care should be taken to avoid exposure. Often a little mustard 
added to the water will increase the efficacy of this treatment. 

Under the name of" Dewees's Emmenagogue Mixture," first devised 
by Professor Dewees, of Philadelphia, the following formula has been 
largely used in functional and organic amenorrhoea : 



R . — Tinct. ferri. chloridi 
Tinct. cantharidis 
Tinct. guaiac. ammon. 
Tinct. aloes . . . 

Syrupi .... 

S. — Tablespoonful three times a day. 



. f.^ss. 
ad f^vj. M. 



ANEMIA. 

The theory of Bunge that the presence of sulphur in excess in the 
body prevents the assimilation of iron, and its indorsement by Clark, 
is not generally received as correct ; for they claim that in chlorosis 
sulphides are formed in excess, and that this causes chlorosis by non- 
assimilation of iron, so that the question at once arises, How did the 
chlorosis come on in the first place, before the sulphides were formed ? 
Sulphides may aid in its continuance, but it is not proved that they 
produce it, and it is proved that they are often present in enormous 
quantities where no chlorosis occurs. Again, we have no proof that 
the manufacture of hsemoglobin depends upon the absorption of iron 
alone. Clark thinks that when we give iron to such a case the sul- 



388 DISEASES. 

phides unite with it and the iron in the food escapes into the blood- 
making organs. Either the doses of iron must be very accurately 
fitted to the amount of sulphides, or excessive amounts must be used, 
so that no sulphide may be companionless. As nearly all persons have 
sulphides present in sufficient amount to make a characteristic black 
stool on taking iron, we should, according to this theory, all have 
anaemia unless we protected the iron in our food by a constaut use of 
the free metal. 

Practical experience does not support the use of enormous doses of 
iron in anaemia and chlorosis, but rather the contrary. The celebrated 
teachers of the Dublin school years ago put forward the theory that 
small doses of iron were more useful than large ones in direct ratio to 
the severity of the disease, and the writer decidedly agrees with them. 
There is quite as much likelihood of failure of assimilation of iron 
by diseased organs as of its destruction by wolf-like sulphides. The 
use of large doses of iron is, however, necessary in obstinate cases of 
anaemia. 

We learn from practical experience several things which science 
does not tell us, namely : Iron will not cure all cases of chlorosis or 
anaemia, even if they belong to a functional type, but other methods 
must be resorted to at the same time, or separately, for their cure. The 
insoluble salts of iron are better remedies for absorption than the 
soluble salts, because they are not precipitated in the stomach, and for 
this reason reduced iron is the best chalybeate for uncomplicated cases. 
Beside using iron in this form, we should employ laxatives if the 
bowels are confined, mineral acids, particularly nitric and nitro- 
muriatic, for their effect on the function of the small intestine and 
liver, and, in addition, bitter tonics of a more or less simple form ac- 
cording to the exigencies of the case ; using quinine if malaria seems 
lurking in the body, simple bitters if the stomach lacks tone, aromatic 
bitters if, from atony of the muscular coats, the digestive tract seems 
sluggish, with a resulting formation and accumulation of flatus and 
digestive juices. 

The preparations of iron best employed in anaemia are the insoluble 
salts just named, such as Quevennes' iron and the carbonate, but there 
are indications which must be regarded as to the salt to be used. In 
many anaemic persons, particularly females, the tongue is broad and 
white, not from coating but pallor, is flabby and torpid-looking. 
Under these circumstances the bowels should be kept moving by mild 
purges, and the sulphate or some other astringent preparation of iron 
be taken by the patient. In the anaemia caused by rapid childbearing 
and lactation, cod-liver oil, the hypophosphites and phosphates of lime 
should be used, while the iron and quinine in tonic dose may be of 
service in all forms of the disease. With some practitioners Bland's 
pill is very much used, made as follows : 

R. — Ferri. sulph."exsiccat. \ -- .. 

Potassii carbonatis j ^ ^ 

Syrupi q. s. M. 

Ft. in pil. no. xlviii. S. — One to three pills three times a day, after meals. 



ANJ1MIA. 389 

Although it is perfectly true that we have almost no knowledge 
of the manner in which alteratives act in instances of disease where, 
through morbid functional activity, enlarged glands or growths ap- 
pear, it is evident that they must act upon the trophic nerves or directly 
upon the nourishment of the affected parts. If they are used in large 
quantities they act as depressants to the normal nutrition of the body, 
producing primarily a decrease in the vitality of morbid growths, so 
that they melt down and disappear, and they may finally so reduce the 
condition of the healthy tissues as to cause sloughs and ulcerations. 
Whether these changes are due to over-stimulation of nutrition — that 
is, to an excessive trophic change — or whether they depend upon 
actual lowering of the tone of the parts, we do not know. One thing 
we do know, however, and that is, that small doses of most of the so- 
called alterative drugs act as very distinct stimulants to the develop- 
ment of normal structures, and in no instance do we find this more 
typically represented than in the effect which they exert upon the blood. 
Quite a number of years ago Keyes, of New York, emphasized the 
value of minute doses of mercury bichloride in syphilitic and other 
anaemias, and abundant clinical observation has certainly confirmed his 
views. The dose of bichloride of mercury in anaemia should be about 
-^q of a grain. Not only will minute doses of the bichloride of mer- 
cury act in this way, but small amounts of calomel or mercury itself 
will have such an effect. 

Inunctions of very small amounts of mercurial ointment once a day, 
or every other day, in adults and in children, will increase the fulness 
and redness of the cheeks and lips, and the number of the corpuscles ; 
the piece of ointment used being no larger than the half of a very 
small pea. This treatment will be found of service in cases not neces- 
sarily dependent upon specific taint or scrofula. The marked increase 
in the nutrition of children of a syphilitic taint who are suffering from 
marasmus, under the use of gray powder and inunctions, gives further 
evidence of this fact. 

Arsenic, also, is of value in anaemic conditions, and may be em- 
ployed in relatively larger . doses than mercury, but, nevertheless, 
smaller amounts than are usually given in chorea and similar states. 
Osier has shown the value of the drug in anaemia, and so has Barton 
in England. Any one of the preparations of arsenic may be employed, 
but not more than -^ grain of arsenious acid should be taken in a 
day, although more has been used with no less benefit to the patient. 
Most of the drug, under these circumstances, is in excess, and is cast 
off in the urine and faeces unused and wasted, straining and irritating 
the emunctories of the body during its passage through them. 

Arsenite of copper is also a remedy of very considerable value under 
these circumstances in the dose of from T ^-g- to ■£$ of a grain three times 
a day. 

Bullock's blood, fresh, or dried and re-dissolved, may be used by the 
rectum in the treatment of anaemia in those cases where iron fails, and 
a change of air and diet may often produce a cure which no drug can 
bring about. 



390 DISEASES. 

Diet is an important part of the treatment of anaemia. The food 
should be good, well flavored, and varied, as well as easy of digestion. 
It should contain, as far as possible, the remedies needed by the sys- 
tem, such as bone salts, iron, and alkalies, and should be accompanied 
by some red wine, such as port. 

At present we may conclude that pathology has not found out the 
real cause of these troublesome cases, and that until physiology can 
put its finger upon the most intricate mechanism of blood-making 
with a positive, clear statement of its function and the physiological 
chemistry of the manufacture of haemoglobin, we must remain satis- 
fied to resort to the remedies which experience or common sense tells 
us will be of value to our patients. 



ANAL FISSURE. 

This is one of the most painful affections to which man is subject, 
and requires intelligent treatment, generally by surgical means if the 
result is to be curative, although great relief can be obtained by the use 
of drugs. 

The most painful and annoying feature of the lesion is the violence 
of the pain on defalcation, which is so severe that any emptying of the 
bowel is impossible except on rare occasions, when the pain is concen- 
trated in one effort. 

To relieve this pain and enable the patient to have a fairly com- 
fortable stool, nothing is so good as an iodoform suppository contain- 
ing 2 to 5 grains of the drug. Iodoform being a local anaesthetic the 
passage takes place almost without the patient's knowledge. If much 
spasm of the sphincter is present, extract of belladonna, J grain, may 
be added to each suppository. For the cure of the fissure a drop of 
strong carbolic acid may be applied to the spot, and a lotion of tannic 
acid, glycerin, and water used if haemorrhoids are also present. 
Ringer highly recommends the application to the fissure, by means of 
a brush, of a solution of bromide of potassium, 1 \ drachms to 1 ounce 
of glycerin. In order that the passages may be soft and yet the 
patient not be purged, sulphur should be given in the dose of one tea- 
spoonful every night ; or, if this cannot be used, castor-oil may be 
given. 

The best way to give the sulphur is by combining it with powdered 
cinnamon or aromatic powder. Sometimes relief is obtained by the 
use of flexile collodion painted over the fissure. 



ANEURISM. 

The treatment of aneurism by drugs is, unfortunately, not very suc- 
cessful, but is at least worthy of trial in all cases. Vascular disease 
resulting in such a lesion depends upon so many causes which may 
modify the treatment that the history of the case should be well borne 



ANGINA PECTORIS. 391 

in mind. The most common causes are syphilis, rheumatic taint, and 
traumatism, and very often injury is superimposed upon one of the 
systemic taints named. Whatever the cause of the disease may be, 
iodide of potassium is par excellence the remedy most apt to do good, 
and it will nearly always give relief, even if it does not cure. 

The doses should be large, 10 to 20 grains three times a day, if the 
patient will bear them, and the prognosis under this treatment is far 
more favorable if the cause be syphilis than if the disease be idio- 
pathic or traumatic. For its successful use the recumbent position 
must be insisted upon and the patient kept quietly in bed, changing 
his position as little as possible and confining himself to the most 
simple and easily digested diet, with entire avoidance of all stimu- 
lating substances, either in the way of food or drink. If the heart is 
excitable and irregular and the vascular system irritable with a high 
arterial tension, the circulation must be quieted by small doses of 
veratrum viride, say 1 or 2 drops twice or thrice a day, but digitalis 
is not to be employed, since it increases the strain upon the aneurismal 
sac, although it does quiet the irregular heart-beat. Aconite may 
also be used with care, but it is inferior to veratrum viride. If the 
pain be very great, and it often is severe, particularly at night, opium 
is indicated and sleeplessness should be allayed, not by full doses of 
morphine, but of morphine and chloral ; or, better still, croton-chloral 
should be so ordered that the patient receives ^ grain of morphine and 
10 grains of croton-chloral in pill at bed-time. All attempts to cure 
aneurism by the use of other drugs, unless syphilis indicates mercury, 
are useless when the lesion is thoracic or abdominal, and when it 
occurs in the extremities, as in popliteal aneurism, surgical measures 
are to be resorted to as the chief means of cure. If dyspnoea in 
thoracic aneurism is marked, slight inhalations or " whiffs" of chloro- 
form are useful. 

As we do not know how alteratives act, other than that they govern 
nutrition, we cannot explain the value of iodides in aneurism. 



ANGINA PECTORIS. 

As the condition which exists in angina pectoris, so far as pathology 
and morbid anatomy are concerned, is unknown, it is impossible for 
us to establish any scientific basis for the employment of drugs in the 
cure of this disease. The nearest approach to any such attempt is 
that first proposed by Lauder Brunton, and is but another evidence 
of the value of studies of the action of drugs upon animals, since he 
argued that as he found nearly all attacks of angina pectoris were 
associated with vascular spasm, that vascular spasm might be the 
cause of the paroxysm, and that a drug decreasing this spasm would 
in consequence be of service. From his researches upon animals with 
the nitrites he knew that this class of compounds would fulfil the 
indications. Whether the vasomotor excitement is " cause or effect" 
we do not know, but we do know that drugs which decrease arterial 



392 DISEASES. 

pressure often give relief in the attack if it be associated with high 
arterial pressure, and may even eventually produce a cure. Further 
than this, we know that nitrite of amyl, nitrite of sodium or potas- 
sium, and nitroglycerin, are of this class. All of these drugs lower 
blood-pressure at once and powerfully, but the nitrite of amyl and 
nitroglycerin are the best remedies for the attack itself, and the nitrite 
of potassium or sodium for the intervening periods, or where the 
paroxysm is prolonged. The reason for this lies in the fact that the 
sodium and potassium salts are more stable than the other two com- 
pounds, are more slowly broken up in the body, and therefore more 
prolonged in their effects. In an attack, a few drops of the nitrite 
should be given by inhalation from a handkerchief, or the nitro- 
glycerin can be used in the dose of 1 drop of a 1 per cent, solution 
by the mouth. The dose of the sodium and potassium nitrites is 
3 grains three times a day, but all these drugs are useless unless the 
arterial tension is high and the heart throbbing or irregular in its 
exercise of power. If vascular relaxation is present, they should be 
supplanted by stimulants, such as alcohol, in full dose, in warm 
water. 

Digitalis may be given during the attack to stimulate the heart, if 
it is weak, and between the attacks to improve its condition. The 
writer has found 20-grain doses of antipyrine of great service in some 
cases. Ether given hypodermically is often of service, but Hoff- 
mann's Anodyne may be used by the mouth instead of ether. 

If the nitrite does not relieve the pain, or if it cannot be used, 
morphine must be given hypodermically in the dose of \ to \ grain, 
but it should never be given by the mouth under these circumstances, 
as its absorption will be too slow aud its effects will come on after the 
pain has ceased. 

In that form of angina pectoris occurring in nervous females, 1 
drachm of ether in ice-water or capsule will often abort the attack, 
or if the paroxysm is caused by dyspepsia and if the stomach be 
overloaded, the sufferer may be relieved by the stomach-pump. The 
cure of the patient rests upon the elimination of all causes which can 
possibly produce a nerve-storm from cardiac irritability, and in the 
administration of arsenic in full dose for long periods of time. Phos- 
phorus is another remedy which is of undoubted value, and should 
always be tried in the dose of jfa grain three times a day after 
meals. 

The diet should be moderate and easy of digestion, and salads, 
lobster and similar articles of food abandoned. If the patient is 
inclined to take exercise of a violent character he must be restrained, 
but some exercise must be insisted on if it is possible. 

Tonics, fresh air, freedom from mental worry and avoidance of ex- 
posure and cold are also necessary. 

Cocaine has been highly recommended for the cure of angina 
pectoris, but is as yet untried, except in a few cases. 






APOPLEXY. 393 



ANOREXIA. 

Anorexia is only a symptom of disease, generally associated with 
debility or other systemic disorder, such as fever or many exhausting 



It is best treated by a careful diet, the use of the bitter tonics, such 
as gentian, cardamoms, and the mineral acids, or by the use of one of 
the following prescriptions : 



Or, 



R. — Acid arseniosi . . . . . . gr. .}. 

Extract nucis vomicae . . . . gr iv. 

Quininse sulph gr. xx. M. 

Ft. in pil. no. xx. S. — One t. d after meals. 

R. — Acid, hydrochlorici dil f.fss 

Tinct. cinchona? co mp. . . . . f^vj. M. 

S. — Dessertspoonful three times a day, after meals, well diluted with water. 



For the use of other bitter tonics see Calumba, Quassia, Chamo- 
mile, Cardamom, and Strychnine. 

None of these drugs are suitable if there is any acute irritation or 
inflammation of the stomach or intestines. (See Indigestion.) 



APOPLEXY. 

When a person suffers from a stroke of apoplexy the chief aim of 
the physician must be to lower the blood-pressure, and so to decrease 
haemorrhage, and as the blood-pressure is nearly always excessive 
under these circumstances its reduction may be considered as a routine 
treatment. If the person be at all full-blooded copious venesection is 
to be employed, any one of the veins in the arm on its anterior surface 
being most convenient. (See Venesection.) At least one pint should 
be withdrawn and the condition of the pulse carefully noted. If 
bleeding is impossible, veratrum viride or aconite must be used to 
lower blood-pressure, the latter in full dose, 5 drops of the tincture. 
Hot mustard plasters must be applied to the feet or a warm mustard 
foot-bath be used, if this is practicable. Ice in an ice-bag or wrapped 
in a tow r el may be applied to the head, and if vomiting comes on care 
must be taken that the stertorous breathing does not draw into the 
lungs particles of the ejected food. Sometimes croton oil, 1 drop, 
placed on the tongue with five drops of sweet oil, may cause a 
depletant catharsis, or J grain of elaterium may be used. The head 
must be kept high and the feet low down. These are the methods to 
be used immediately after the rupture of the bloodvessel. 

The object to be sought, after the " stroke " has occurred and the 
haemorrhage has ceased, is the removal of the extravasated blood, the 
restoration of function in the paralyzed parts, and the prevention of 
secondary lesions consequent upon inflammation of the brain as a 
result of the injury to its substance. If the patient survives the 



394 DISEASES. 

attack no drugs should be used, save arterial sedatives, for one or two 
days, until the clot in the ruptured vessel has become firmly fixed, 
uuless symptoms of meningitis arise, when these drugs must be 
pushed, and opinm and calomel administered in small antiphlogistic 
doses, \ grain of each every four hours. Meningitis and cerebritis 
rarely occur if the veratrum viride or aconite is properly used. After 
the clot is firmly formed and has plugged the bloodvessel we may 
proceed to take measures for the absorption of the exudate, the chief 
measure consisting in the use of iodide of potassium in as large doses 
as the patient will bear without the production of iodism. This drug 
should not be resorted to until several days, or even two or three 
weeks, have elapsed since the attack. 

Mercury in small doses may also be given. 

In order that the muscles of the extremities may not waste and 
become powerless from disuse, passive exercise, rubbing, and, if possi- 
ble, massage must be resorted to. Electricity may be applied to them 
in the form of the slowly interrupted current, and strychnine may 
be used hypodermically or by the mouth, as a stimulant to the 
trophic centres in the spinal cord. None of these measures are to be 
employed if any inflammation exists in the brain, as they will in- 
crease the cerebral disorder, and at least three weeks should elapse 
after the attack before they are resorted to. 

Electricity applied to the head to remove the lesion is useless, as the 
current does not go through the brain, but around the skull by means 
of the scalp. 

A very careful diet is to be maintained. Meats are to be used very 
sparingly, the bowels maintained in perfect regularity, and no wines 
are to be taken nor any stimulants used, lest they cause a second 
rupture of the weakened vessel in the brain. 

Apoplexy must be carefully differentiated from acute alcoholism 
and opium poisoning, whicli it much resembles. (See Alcohol.) 

If respiration fails, nothing can be done with much advantage, but 
belladonna or strychnine may be given hypodermically. The use of 
electricity to stimulate the phrenic nerve and diaphragm when respira- 
tion fails is a remnant of senseless medical practice and is particularly 
useless in apoplexy. (See Asphyxia.) 

Above all things stimulants are contra-indicated, even though the 
pulse fails, as they increase the haemorrhage into the brain. 



ASPHYXIA. 

With the advent of the production of artificial anaesthesia by the 
use of certain chemical compounds the importance of this subject 
necessarily became enormously increased, and no one can doubt that 
the majority of cases of arrested respiration depend for their exciting 
cause upon such agency, or to the inhalation of noxious gases. It is 
of the greatest importance that a clear idea of the necessities of the 
case be grasped by the physician under such circumstances, and that his 



ASPHYXIA. 395 

action be one of rapidity and clearness so far as the ultimate result 
which he seeks is concerned. By some curious fallacy of teaching 
the greater part of the profession have been taught to faradize the 
diaphragm into contraction with the rapidly interrupted electrical 
current, by the application of one pole over the phrenic nerve in the 
neck and the other over the abdomen. It requires but little thought 
to show that such a method is ludicrous in the extreme, for by using 
such a current on any muscle, we produce a condition of spasmodic 
contraction or tetanus. Everyone knows that the diaphragm relaxed 
by paralysis or contracted by spasm, so long as it is immovable, is 
equally harmful to the patient. If any current is to be employed, it 
should be that which is slowly interrupted and which will alternately 
contract and relax this important respiratory muscle. There can be 
little doubt that the rapidly interrupted current has caused persons 
to renew their respiratory movements, but in these cases the result 
has been dependent almost certainly on the reflex excitability of the 
cells in the spinal cord and medulla rather than on an action upon 
the phrenic nerve. If such an action is required, the poles of the 
battery may be swept over the body so as to cause peripheral 
irritation. 

The absurdity of the application of the rapidly interrupted current 
to the phrenic nerve is not alone dependent upon the points we have 
named. It has recently been proved by careful observation on the 
part of Dr. Martin and the author that the application of the 
electrode over the pheuic nerve in the neck may cause cardiac arrest 
through diffusion of the current to the vagus nerve, and Griswold 
reached conclusions of an identical character in the year 1885. 

If electricity is used, it should be employed solely as a peripheral 
irritant, with the object of arousing the patient, as would a dash of 
cold water. 

The question at once arises as to the best thing to do when such an 
accident occurs. If the arrest has occurred when the patient is under 
chloroform, his head should be lowered and the feet raised almost 
perpendicularly. The neck should not be extended but held in the 
normal position, so that the chin is somewhat shot forward and at a 
right angle to the body line. If the neck be extended the glottis does 
not open as well as when the position named is assumed. While one 
assistant supports the head in this position, another should use artifi- 
cial respiration by Sylvester's method, and it will then be readily seen 
that there is an increased volume of air passing in and out of the chest. 
The drawing forward of the tongue is not so important as is imagined, 
unless it is pulled upward and toward the teeth in the upper jaw. 
The use of ammonia, when given intravenously into the leg, as a 
rapidly acting respiratory and cardiac stimulant, may be resorted to, 
and dashes of cold and hot water should be employed, not only for 
their excitation of the peripheral nerves, but also for the purpose of 
keeping the bodily temperature from rising above or falling below the 
normal line, the latter danger being, of course, the most pressing. 
The hypodermic injection of ether during asphyxia from ether anses- 



396 DISEASES. 

thesia is a ridiculous therapeutic attempt, for if the system, and 
respiratory centres are so depressed by the ether already taken into 
the blood through the lungs as to have their functions in abeyance, 
why should we add still greater depression by injecting more of the 
same drug? Let everything that is done be born of sense and 
thoughtfulness of the exact action and result desired, and let nothing 
be done simply because some other person has done it, great though 
he may be in the practice of the healing art. Measures for the relief 
of persons suffering from any malady depend not upon empirical 
laws, but upon the good common sense of the physician in charge, 
even if the measure is a most revolutionary one in character. 

When practising artificial respiration in cases of asphyxia, Syl- 
vester's method should always be employed. This consists of laying 
the patient on some hard, flat surface, kneeling above his head, and 
then, after grasping the arms at the elbows, to bring them upward 
and outward, so that they follow the plane on which the body is ex- 
tended. This movement causes expansion of the chest or inspiration. 
After a moment's pause the arms are lifted up and brought toward 
one another, and then, while still approximated, pushed down to 
their original position upon the floating ribs upon which they are 
pressed. This last movement drives out the air from the chest, or 
causes expiration. These movements should be at the rate of from 
sixteen to twenty per minute, about that of normal respiration, and 
be persisted in for at least forty-five minutes even though the case 
seems hopeless, as cases have recovered after as long a period of appa- 
rent death as an hour. While they are being carried on, the patu- 
lousness of the upper air-passages is to be maintained. In some 
researches made by Dr. Martin and the writer, the following rules 
regarding the position of the head, neck, epiglottis, and tongue were 
formulated : 

The fingers are passed behind the angles of the lower jaw, and the 
latter is pressed forward ; this elevates the epiglottis and the base of 
the tongue about a quarter of an inch from the post-pharyngeal wall. 
Extending the head and pushing it forward so that the neck makes 
an angle of forty-five degrees with the plane of the table, draws the 
base of the tongue and the hyoid bone far forward, this motion being 
at the same time imparted to the epiglottis, so that the latter stands 
upright and is separated from the posterior wall of the pharynx by 
an interval of about an inch. By tightly closing the jaw the antero- 
posterior space is still further increased. 

The epiglottis may prevent free entrance of air to the lungs even 
though the tongue is pulled forward. Any means which accom- 
plishes the anterior projection of the hyoid bone immediately and 
infallibly raises the epiglottis and the base of the tongue, and the 
hyoid bone may be made to project anteriorly by direct pressure 
upon its cornua, by direct pressure or traction applied to the tongue 
far back behind the anterior half arches of the palate and by the 
action of gravity in the abdominal decubitus, or by extension of the 
head upon the neck, although flexjon of the neck with extension of 



ASTHMA. 397 

the head upon the neck does away with the epiglottis as an obstructing 
factor as completely as any other posture. 



ASTHENOPIA. 

Asthenopia, or weak sight, depends upon exhaustion of the power 
of accommodation in cases of refractive error, usually hypermetropia, 
or upon insufficiency of the external ocular muscles. The former is 
sometimes called accommodative asthenopia, and the latter muscular 
asthenopia. The treatment of these conditions requires the prescrib- 
ing of the proper pair of glasses, combined, if necessary, with prisms, 
and with systematic exercise of the ocular muscles. Locally, a weak 
solution of the sulphate of eserine or pilocarpine acts as a stimulant to 
the ciliary muscle, and internally good results follow the use of large 
doses of the tincture of nux vomica or of strychnia. 

R. — Eserinse sulph gr. ¥ 3 T . 

Aq. destill f |j. M. 

S. — 2 drops night and morning. 
Or, 

ft. — Pilocarpin. nitrat gr. ^V- 

Aq. destill f £j. M. 

S. — 2 drops night and morning. 

Another form of asthenopia is termed neurasthenic asthenopia, or 
retinal anmsthesia, and presents a number of eye symptoms in connec- 
tion with a general depression or debilitated state of the nervous 
system, the eye itself, however, being a healthy organ. The chief 
symptoms are fluctuation in visual acuity, rapid disappearance of 
objects looked at, contraction of the field of vision, imperfect retinal 
images, often associated with dread of light. The mere prescription 
of glasses in these cases to correct any refractive error is not suffi- 
cient. Much relief will often be obtained if hot compresses at 110° 
F. be made to the closed eyelids for five minutes at a time. The 
patient requires the same general treatment that would be applied 
to any neurasthenic case. All the functions of the body must be care- 
fully examined into and placed in as normal a condition as circum- 
stances will allow. Especially valuable are rest, massage, salt baths, 
and full doses of strychnia, together with iron if there be ansemia. 



ASTHMA. 

Asthma is one of the most difficult diseases to successfully treat that 
the physician has to deal with. 

The disease in all its forms depends upon interference with the free 
entrance and exit of the air to and from the lungs, and this is gen- 
erally if not always dependent upon a spasm of the muscular fibres 
in the walls of the bronchial tubes, although it has been asserted to 



398 DISEASES. 

be due to a sudden swelling or hypersemia of the bronchial mucous 
membrane. Both of these states are probably present in varying 
degree in all cases. 

The spasm has been proved by Longet, Williams, Romberg, Paul 
Bert, Bierner, and very recently by Sandmann, to be due to a neurosis 
of the pneumogastric or vagus nerve, while the swelling of the mucous 
membrane has been seen by Stoerk and others. This has formed 
two schools of teaching concerning the pathology of this disease, when 
a little attention to the physiology of the subject would at least show 
that no difference need exist, the vagus nerves governing not only the 
muscular fibres, but also the bloodvessels of the bronchial tubes. 
The discovery of Michaelson that injury of the recurrent laryngeal 
nerves causes catarrhal inflammation of the bronchial tubes, particu- 
larly those of the upper lobes, renders the analogy between acute 
asthma and laryngeal spasm which has been spoken of by many 
writers still more interesting. 

One other step remains for a thorough understanding of the manner 
in which the disease is produced. Gastric, dyspeptic, or intestinal 
asthma arises from indigestion, as its name implies, and is caused by 
the irritation of the afferent filaments of the vagus in the walls of 
the stomach and intestine, thereby causing reflexly a contraction and 
hyperemia of the bronchial tubes. In a similar reflex manuer hyper- 
trophies of portions of the nasal chambers or abnormal conditions of 
the nasal mucous membranes in general may result in an asthmatic 
attack. 

Having obtained some idea of the cause of an attack, let us turn to 
the treatment of the affection. 

By far the most serviceable remedy in asthma is belladonna, which, 
as has been pointed out when that drug was studied (see Belladonna), 
exercises in medicinal dose a decided sedative and depressing influ- 
ence on the peripheral filaments of the vagus nerves, not only so far 
as the heart is concerned, but also upon bronchial secretion, which is 
always diminished by the drug, probably by its vagal influence. 

It is evident, therefore, that the use of belladonna or atropine 
although originally employed in an empirical manner, is really based 
upon rational ideas, and as the physiological action of stramonium, 
hyoscyamus, and similar members of this group is nearly identical with 
belladonna, their influence for good is also explained. The experiments 
of Ott proved that lobelia is a peripheral pneumogastric depressant, 
and those of Rosenthal and the author likewise showed that tobacco 
has a similar effect. The same is also true of nitrite of amyl and the 
other nitrites which also relax unstriped muscular fibre. We have 
before us, therefore, a list of the most efficacious and best anti-asth- 
matics, all of them being depressant to the peripheral vagi. 

The other remedies commonly employed are chloroform by inhala- 
tion, which relaxes the spasm of muscular fibre by its tacal influence, 
and morphine which acts as a nervous sedative, prevents reflex irrita- 
tion and quiets the patient, acting at the same time as a heart stimu- 
lant and unloading the engorged cardiac cavities. The relief obtained 



ASTHMA. 399 

by the inhalation of the fumes of nitrate of potassium, See asserts, 
depends upon the formation of the protoxide of nitrogen and carbonic 
acid gas, which act as local anaesthetics. 

The practical treatment of an attack of asthma consists in the use 
of morphine kypoderrnically iu the dose of -J- to J grain, alone or in 
combination with atropine. Cigarettes made of paper soaked in a 
solution of nitrate of potassium and belladonna may be used (see 
formula under Belladonna), or they may be made in the following 



manner 



-Foliorum belladonna 
Folio rum hyoscyami 
Foliorum stramonii 
Extracti opii 
Aquse lauro-cerasi 



gr- iij- 

gr- nj- 
gr. h 
q. s. M. 



These various leaves are broken up like commercial tobacco, and 
moistened by adding the cherry-laurel water, which should contain the 
opium. Finally a whole leaf soaked in the same fluid is used as a 
cover, or a piece of cigarette paper may be employed in the same 
manner. 

A remedy very recently brought forward in this country for the 
relief and cure of asthma is euphorbia pilulifera, the fluid extract of 
which may be given in the dose of J to 1 drachm, once, twice, or thrice 
a day. (See Euphorbia Pilulifera.) 

The author finds the following formula very useful in asthma : 



Sodii iodidi 


. gr. ij. 


Potas. bromidi .... 


• g r - ij- 


Ext- euphorbias pilulifera? fi. 


. . IU iij. 


Nitroglycerin! .... 


• gr. 2^0 


Tr. lobelias 


• • mij. 



M. 
Ft. in pil. vel capsul. no. i. S. — From 1 to 4 three times a day. 

It will be seen that each ingredient of this pill has a different action. 
The action of iodides in asthma is well known, as is also that of the 
bromides. The euphorbia pilulifera has been found useful in asthma 
empirically. The nitroglycerin depresses the peripheral ends of the 
vagus nerves and acts as a stimulant to the heart when engorged with 
blood by relieving the inhibitory action of the vagus and relieving the 
bloodvessels elsewhere. The tincture of lobelia acts as a depressant 
to the vagus also. 

The use of amyl nitrite by inhalation, 3 to 6 drops on a handker- 
chief, is invaluable in many cases, and it rarely fails to relieve the 
spasm. Owing to the engorgement of the heart consequent upon the 
embarrassment of respiration, the nitrite must be used with care, and 
in one or two instances it has proved dangerous by causing cardiac 
failure. 

Sometimes tobacco may be smoked, and it is particularly efficacious 
in those who are not accustomed to its constant use. 

Lobelia when employed should be used in full emetic dose (1 drachm) 
in the form of the tincture if an attack is present. If an attack is 



400 DISEASES. 

feared, 10 drops of the tincture every four hours may be given if the 
heart is in good condition. 

A treatment of asthma, which is very successful when it arises from 
nasal disorders, consists in the application to the nasal cavities, at the 
onset of the attack, of the following solution by means of a brush or 
spray : 

I£. — Cocain. hydrochlorat gr. xv. 

Aquae destillat . . . . q. s. ad f £iv. M. 

S. — Apply as directed. 

If this solution is thoroughly applied and the other directions given 
are carried out, very rapid reiief will often be obtained. Unfortunately 
we cannot readily separate those cases which are due to nasal disease 
and those produced by other causes, and in consequence this treatment 
when tried for the first time in a given case is purely experimental. 

The curative treatment of asthma, to a very large extent, rests upon 
the use of iodide of potassium, and in the careful regulation of the diet 
and bowels, particularly if the trouble seems to be dependent upon 
indigestion. As the attacks are generally nocturnal the evening meal 
should be taken early, be light and easily digested, and tea and coffee 
should be avoided at this time. The patient should avoid dusty streets 
and live in the open air as much as possible, and a damp atmosphere 
is usually preferable to a dry one, provided it is not too cold. This 
rule is subject to many variations, and each case will be found to be a 
law unto itself, and must try different climates until the proper one is 
found. Arsenic may be used, particularly if the mucous membranes 
are below par, and a dose of bromide of potassium or sodium, 30 grains, 
half an hour before retiring to bed, may be of service. Grindelia ro- 
busta is largely used as a prophylactic in the dose of 10 to 30 minims 
of the fluid extract three times a day. 

Lobelia may also be used in the form of the tincture, 10 drops three 
times daily. 

Compressed and rarefied air are of service, and inhalations of oxygen 
are valuable if the cyanosis is extreme. 

In some cases the presence of nasal polypi or other irritations of the 
air-passages causes asthma to appear, and they must be removed before 
a cure can be attained. In other instances arsenical wall-papers are the 
cause of the trouble. 



BED-SORES. 

Bed-sores depend upon disturbances of nutrition resulting from 
pressure exercised in such a manner that the local circulation is inter- 
fered with at a time when the vitality of all the tissues is depressed 
by disease or injury. In most instances the part involved becomes 
chafed by creases in the sheets, by crumbs of food, or by moisture 
from the discharges of the rectum and bladder. 

The chief thing to be done is to prevent the trouble by careful 
nursing and cleanliness, which must be supplemented by measures 



BILIOUSNESS. 401 

devoted to the hardeniDg and improving of the skin covering the parts 
where the sores are apt to appear, as over the buttocks and sacrum. 
To permit of a good supply of blood, the patient should be turned 
on one side or the other every few hours and the skin rubbed thor- 
oughly with a dry towel to cause a healthy transudation and absorp- 
tion of the nutritive juices. Salt and whiskey, 2 drachms to the 
pint, may be rubbed over the skin, or tincture of catechu and the 
dilute solution of the subacetate of lead applied to harden it. If this 
is not used, a mixture of alum and spirit of camphor is useful, made 
by adding 1 ounce of powdered alum to the whites of 4 eggs and 
mixing this with 2 ounces of the camphorated spirit. Where the 
skin is very red and angry-looking, but still intact, a solution of 
nitrate of silver of the strength of 20 grains to 1 ounce is to be thor- 
oughly painted over the spot. All these remedies act in hardening 
the skin through their astringency, or by acting as sedative astringents 
to the inflamed capillaries of the part. 

When a bed-sore is developed, measures must be taken for its 
cure and the prevention of its spread. With this object in view 
the body must not rest on the part affected if it can possibly be 
avoided, and in order that the sore may be protected and the pressure 
equalized, a large piece of soap-plaster, with its edges deeply incised 
to make them pliable, should be applied after the sore has been thor- 
oughly washed out by means of a swab or syringe filled with a 1 to 
5000 solution of bichloride of mercury, and afterward dusted with 
iodoform. Sometimes large squares of lint heavily covered with zinc 
ointment are serviceable in lieu of the soap-plaster. If the sores 
spread and burrow through the parts the sinuses should be freely 
opened and irrigated, all dead tissues being cut away to avoid sepsis. 

Nitrate of silver in the strength of 20 grains to 1 ounce may also 
be used as the patient recovers, if the ulcers seem sluggish, and a 
smooth slip-sheet should ahvays be placed under the buttocks. If 
possible, supportive measures and an increased amount of predigested 
food should be given if the sloughs are large. The internal use of 
iron is particularly valuable in the form of the tincture of the chloride. 



BILIOUSNESS. 

This is a term used to designate a state which presents different 
symptoms in different cases, but always includes languor, headache, 
or dizziness, perhaps some yellowing of the skin and conjunctiva, 
and a general sense of atony, mental depression, and discomfort. It 
depends not upon an excessive secretion of bile, but upon some 
perversion of its function or secretion, or its retention in the bile- 
ducts. Further than this, most of the symptoms do not depend 
directly upon the changes in the bile, but upon failure of proper 
digestion in the stomach and intestine, coupled with the development 
of irritative decomposition-products of various kinds. The stomach, 
intestine, liver, pancreas, and their juices all form a complex inter- 

26 



402 DISEASES. 

woven chain of function in which if one link breaks the entire chain 
becomes disturbed. The entrance into the stomach of certain food- 
stuffs which are either ill-prepared or improper for gastric digestion 
rapidly causes the development of active fermentation and a split- 
tiug-up of these bodies, with the formation of lactic and butyric 
acids, which irritate the gastric mucous membrane and thereby bring 
about a faulty gastric secretion of mucus, which aids in making still 
further trouble. By the same means the circulation of the stomach 
is disturbed and becomes abnormal, and the intestine, liver, and 
pancreas receive reflex irritation to which they are not normally ex- 
posed. Further than this, the irritated stomach fails to convert its 
contents into peptones and the general features of chyme, and too 
early or too late drives out into the duodenum a mass of semi-digested 
and fermenting material, utterly unfit for intestinal digestion and 
absorption, thereby disordering the functions of these parts still 
further at a time when they are not prepared for the reception of any 
food. The secretion poured out by the different glands varies from 
the normal, the alkaline juices are not able to overcome the normal 
acid of the gastric juice plus the lactic and butyric acids, aud finally 
the reaction of the intestine becomes acid instead of alkaline, with re- 
sulting irritation and secretion of morbid juices and mucus. The 
trouble when existing in the stomach gives rise to headache and dis- 
comfort, a bad taste in the mouth, and perhaps pain, and is followed 
by fever, languor, jaundice, and flatulence when the intestine is 
affected. The cause of these symptoms rests upon the fact that while 
gastric juice and bile are antiseptic, pancreatic juice mixed with food 
undergoes rapid decomposition with the development of products of 
decomposition such as skatol and indol and a large number of poison- 
ous alkaloids. Normally these are not allowed to form, owing to the 
presence of antiseptic bile, which also hurries on the absorption of 
the food, but if the bile is retained in its ducts its secretion is impaired 
and its constitution altered by the disorder of the liver which results 
reflexly from the gastric and intestinal irritation. Unfortunately the 
complication does not cease at this point, for the liver in health has 
other functions to fulfil, one of the most important of which is the 
arrest and destruction of all poisons of an organic character which 
come to it from the stomach and bowel. Not ouly are decomposition- 
products destroyed by it, but all the vegetable alkaloids are rendered 
innocuous if present in ordinary amounts. 1 The disorder of hepatic 
function, therefore, permits the entrance into the general circulation 
of these substances, which are very various as regards their powers 
and effects. Thus Brunton has pointed out that one of these com- 
pounds closely resembles curare, in that it poisons the peripheral ends 
of the motor nerves, and thereby is at least partly responsible for the 
muscular relaxation and languor often seen in patients suffering from 
so-called '* biliousness." Other substances act as do digitalis, atro- 

1 See studies of ScliifF, Lautenbach, and many others, including Ludwig and 
Schmidt-Mulheim . 



BILIOUSNESS. 403 

pine, muscarine, and picrotoxin, and the number of these various 
compounds is infinite. 1 

It is impossible to give space to a further consideration of these 
poisons, but what has been said shows clearly that " biliousness " 
only expresses a state in which absorption of the bile is not the sole 
cause of the symptoms, but that other poisons are at work. The 
methods of treating biliousness are therefore not to be considered as 
depending upon some regular routine, but upon a study of the case 
and its symptoms. 

Very frequently after several days of minor discomfort, the attack 
culminates in a severe sick-headache, after which vomiting comes on 
and relief is obtained almost at once. Such patients can generally be 
relieved in the very first part of their discomfort by emetic doses of 
ipecac or aponiorphine, 30 to 60 grains of the former, or yL- grain of 
the latter hypodermically. The manner in which this treatment does 
good is very evident. It compresses the liver and expels inspissated 
bile by the compression exercised by the abdominal walls and dia- 
phragm in the effort of vomiting and thoroughly excites to normal 
secretion the torpid glands of the stomach and intestine. 

The vomitiug also rids the stomach of the fermenting masses and 
bacteria contained in them, and renders the alimentary canal pure. 
This purity may be increased between the paroxysms by draughts of 
warm water, or water containing a few grains of bicarbonate of 
sodium or salicylic acid. 

When it becomes evident that an attack is about to begin, that is, 
when constipation, slight drowsiness or languor after meals show the 
tendencies present, one of two drugs should be used, either podophyllin 
if the stools be dark, or calomel if they be light-colored. One-sixth 
grain of the former to an adult is generally enough, or 1 grain of calo- 
mel divided into six powders, one of which is to be taken every fifteen 
minutes, is a good dose, to be followed in four hours by a saline. If 
the attack is sudden in its onset no time is allowed for these hepatic 
stimulants, and a saline should be used in a good-sized dose at once, 
not because it causes a flow of bile but because it sweeps the poisonous 
matters out of the gut before complete absorption can occur and aids in 
restoring the normal intestinal alkalinity. 

The prevention of " biliousness " depends upon the maintenance of 
a normal, easily digested diet, upon the formation and excretion of 
normal bile, and the prevention of fermentation and decomposition in 
the alimentary tract. 

The term " normal diet " is a very elastic one, and varies with each 
case. While certain forms of food are generally considered good or 
bad, easy of digestion or difficult of assimilation, it nevertheless 
remains a fact that many of the simplest foods are capable of acting 
as poisons. A large number of persons cannot take milk or eggs 
because their digestion of these substances is faulty, and the writer is 

• x See the researches of Schweringer, Zuelzer and Sonnerscheim, Bence Jones, 
Dupre, Rorch and Fasbender, Brieger, Schmiedeberg and Harnach. 



404 DISEASES. 

cognizant of one case where lobster salad can be eaten at bed-time with- 
out discomfort while an egg at breakfast will cause a severe headache 
or pain in the belly. Rules as to diet must not be " iron-clad," but 
based on observation. 

By far the best means of maintaining hepatic activity in cases where 
this organ is torpid is horseback exercise, particularly if the exercise 
is taken on a trotting horse, as the jolting of the liver keeps the chain 
of digestive functions active and prevents the secretions from becoming 
clogged. Along with this exercise massage of the hypochondrium aud 
belly walls is useful, and the movement of stooping over, bending from 
side to side, and bending backward with the feet close together, is of 
value. Coffee is often the cause of biliousness because of its oil. 

The use of pure, dark orange- colored undiluted nitro-muriatic acid 
in these cases in the dose of three drops three times a day in half a 
tumblerful of water is invaluable, and the fluid extract of stillingia in 
the dose of 20 drops is of service, as is also the solid extract of euony- 
mus in the dose of 3 grains. Five-grain doses of extract of chirata in 
pill are also useful in hepatic atony of a mild type. 

The knowledge of the action of many of the poisonous materials 
formed in the alimentary canal renders it possible for us to relieve the 
patient by other means than those which may be generally resorted to 
when the attack is present. Thus, if the pupils are dilated, the skin 
hot and dry, the eyesight dim, and the pulse rapid, the alkaloid pro- 
ducing these signs of atropine poisoning may be antagonized by opium 
in small dose, or if the pulse be slow and full, the arterial tension 
high, and there is throbbing in the head with frontal headache, the 
alkaloid representing digitalis may be antidoted by the use of aconite. 
If nervousness and irritation are present, the bromides and chloral may 
be used. 

For some unknown reason, the use of caffeine in the headaches of 
biliousness nearly always makes them worse, particularly if the head- 
ache is due to over-indulgence in coffee. 

If the face is flushed, a mustard plaster or cup to the nape of the 
neck may be used, and a hot foot-bath is often of service. 

In cases where the bilious attacks are associated with catarrh of the 
stomach, intestines, and bile-ducts, chloride of ammonium, in 5-grain 
doses three times a day, is very useful, as is also the protioclicle of 
mercury, when triturated with sugar of milk, in the dose of -fa to -j^-^ 
of a grain three times a day. Frequently the use of salol or salophen 
in 10-grain closes, three times a day, does much good in these cases, 
acting as an intestinal antiseptic. (See Salol.) 



BLEPHARITIS. 

Blepharitis is divided clinically into an ulcerative and non-ulcera- 
tive variety. The indication of prime importance in the treatment 
of this affection is the removal of the scars and crusts before the 
application of the local remedies. This may be accomplished by the 



BOILS. 405 

use of alkaline solutions, bicarbonate of sodium, or biborate of sodium 
(8 grains to the ounce), or a 5 per cent, solution of chloral, as recom- 
mended by Gradle. The salves that have met with the greatest suc- 
cess are Pagenstecher's ointment (yellow oxide of mercury 1 grain, 
vaseline 1 drachm), dilute citrine ointment, pyrogallic acid ointment, 
or a 3 per cent, milk of sulphur ointment, to which resorcin may be 
added. The latter application is useful in the squamous variety alone. 
In the ulcerated form, if the crusts are tenacious, these, as well as the 
stunted cilia, must be removed with forceps, and yellow oxide of mer- 
cury salve, or some similar application, applied. Excellent results 
follow touching the crater-like abscesses, which exist in edges of the 
lid, with nitrate of silver. If there is an accompanying conjunctivitis 
a boric acid solution is suitable, while, under any circumstances, 
obstruction of the lachrymal duct — a frequent accompaniment of the 
disease — must be removed, and the nasal passages explored for any 
chronic inflammatory condition. The relation between this disease 
and the presence of refractive errors demands the correction of the 
latter, should this exist, before a hope for cure may be entertained. 



BOILS. 

Boils are dependent upon an impoverished state of the system, due 
to several causes, or, more rarely, to some local trouble situated in the 
skin, as in the persons of oil or paraffine workers. 

Their constitutional treatment rests upon the use of fresh air, cod- 
liver oil, iron, arsenic, phosphate of sodium, and, if any boils are 
present at the time, the use of the sulphurate of calcium in the dose 
of ^ grain every five hours. The sulphurate of calcium hastens the 
maturation of boils and prevents the formation of new ones, but is 
useless, according to its original user, Dr. Ringer, in the boils which 
appear during the course of some cases of diabetes. 

The local treatment of boils may be divided into the abortive and 
curative methods. The abortive method consists in painting the in- 
flamed spot, when the trouble first begins, with a solution of gun- 
cotton (collodion) and renewing the coat hour after hour until a heavy 
contractile covering is formed. If pus forms under this it may be 
absorbed, but if this does not occur, then the boil must be opened 
under antiseptic precautions and properly dressed. A strong solution 
of nitrate of silver is also very useful at the very beginning of the 
formation of a boil, if painted over the part in the strength of 20 
grains to the ounce. The other local applications consist in the use 
of the extract of opium or belladonna over the part to relieve pain 
and decrease the inflammation. 

Poultices may also be used to relieve the sensation of tenseness and 
mature the boil, and they should contain sweet oil and laudanum. 
Pinger recommends the application of alcohol and camphor over the 
skin in the early stages. After the skin is wiped dry, it is to be 
smeared with camphorated oil. Stelwagon uses the following: 



406 DISEASES. 

Be . — Ichthyol. gj. 

Emplast. plnmbi ^ij. 

Emplast. resinss . . . . . £j. M. 
S. — Apply to the part. 

He also approves of the injection of a few minims of a 5 per cent, 
solution of carbolic acid into the apex of the boil, if its formation is 
assured. 

BREASTS, INFLAMED. 

Mastitis is, from a medical point of view, readily treated. Lacta- 
tion should at once cease, and the breast be dressed by the use of a 
sponge compress, underneath which belladouDa ointment is to be copi- 
ously smeared. Belladonna is a useful remedy both before and after 
very acute inflammation has begun, and its use should be persisted in 
for twenty-four hours. 

At the same time that these measures are resorted to, the circulation 
should be thoroughly impressed by aconite or veratrum viride, and 
mild saline purges should be given. If the milk persists in forming 
it must be removed by the breast-pump. For the surgical treatment 
of mastitis the reader should refer to the books on surgery. 



BRIGHT'S DISEASE, ACUTE. 

The treatment of acute nephritis, accompanied by any active in- 
flammatory change, requires care and intelligence. The pain in the 
loins, and, perhaps, the bloody urine, which is scanty and high- 
colored, febrile disturbance, and the history of exposure or other 
exciting cause, all form a clinical history typical in its major points. 
Here, as elsewhere, for the reduction of inflammation, circulatory de- 
pressants are to be resorted to, and aconite is generally most service- 
able. The patient should be kept quietly in bed and supplied with a 
milk diet, cups or leeches being used over the loins if the urine is 
scanty. Blisters are not advisable, as the irritant substances pro- 
ducing them may be absorbed and cause increased renal irritation, 
The restlessness will generally be quieted by the aconite ; but if this 
fails, resort must be had to bromides, or small doses of opium, which 
must be given cautiously, as these drugs are not readily eliminated 
when the kidneys are diseased. Cannabis indica is thought to be of 
great service if bloody urine is present, but chloral is generally too 
irritating to the kidney to justify its employment. The appearance 
of large amounts of blood in the urine at about the fifth day of the 
illness is an indication, according to Sydney Ringer, for the use of 
drop doses of tincture of cantharides given every few hours. 

If dropsy comes on and is excessive it must be relieved by the use 
of hydragogue purges, such as elaterium, which is particularly useful 
in that it is supposed to aid in the elimination of the urea by the 
bowel. Jaborandi or pilocarpine may be used to sweat the patient at 



bright's disease, chronic. 407 

this time or in the earlier stages with advantage; J- grain of the hydro- 
chlorate should be given hypoderrnically and repeated in fifteen min- 
utes if no sweat appears. Hot-air baths are often useful to provoke 
a sweat. Warm mucilaginous drinks, as flaxseed tea, are of service, 
and the use of the citrate of potassium and the sweet spirit of nitre 
should be resorted to to increase urinary flow. Generally these cases 
go on to recovery, although convalescence is often somewhat pro- 
longed. The treatment of the later stages consists in the use of 
stimulants to the kidneys to arouse them from the atony consequent 
upon the excitement of inflammation. To this end digitalis and 
squill, or digitalis and calomel or caffeine citrate may be used in small 
amounts gradually increased and followed by the compound spirit of 
juniper or gin as the case progresses. If the renal structure is per- 
sistently atonic, J to 1 drop of the tincture of cantharides at each dose 
may be used, and as ansemia is often a prominent symptom, tincture 
of the chloride of iron, which is both diuretic and a tonic, should be 
resorted to. If renal haemorrhage is excessive, gallic acid and ergot are 
indicated to control the bleeding. A milk diet should be rigidly en- 
forced. 

BRIGHT'S DISEASE, CHRONIC. 

The treatment of chronic nephritis is a very different matter, so far 
as prognosis is concerned, from that of the acute form. It is almost, 
if not quite, impossible to cure the condition present, and we can only 
improve the state of the kidneys and other organs by care and the use 
of proper drugs. As Tyson has aptly put it, we must try to arrest the 
development of the renal lesions and improve the general health, treat 
the symptoms which are not dependent upon the nephritis, except 
indirectly, and last, treat those signs which are due to the nephritis 
itself. To arrest the disease all alcoholic drinks should be avoided as 
far as possible, and business cares and worries be cast aside. Great 
care should be taken to avoid cold, and a warm climate is generally to 
be recommended to the patient, since sudden changes of temperature 
tend to produce congestion of the kidneys by the chilling of the skin. 

The diet and drink are important considerations, and should con- 
sist largely of milk. Beyond this we can do little toward a cure. 
To allay symptoms we can do much, and the albuminuria can be 
greatly decreased by the use of digitalis, squill, the acetate and bitar- 
trate of potassium, and the iodides ; nor should the bichloride of 
mercury be forgotten. These remedies are also of value to relieve 
the dropsy, and the most efficacious treatment of all is a combination 
of the bitartrate of potassium and juniper berries, so that 1 ounce of 
the former is dissolved in 1 pint of an infusion of the latter and taken 
in twenty-four hours. If dropsy ensues, hydragogue purges are use- 
ful, such as jalap and elaterium, and hot baths, Turkish or Russian, 
are to be given, not only to relieve the dropsy, but to so hypertrophy 
the excretory glands of the skin that they will be able through greater 
activity to relieve the kidneys. (See Heat.) Sugar of milk may be 



408 DISEASES. 

given in the dose of 40 to 80 grains a day as a diuretic, and butter- 
milk is a useful form of food. (See Sugar of Milk.) 

Ascites or thoracic effusions should be treated by tapping. 

In the interstitial forms of this disease Bartholow has highly recom- 
mended the use of the chloride of gold and sodium in the dose of 
2jto^ grain. The anaemia is to be combated by the use of the 
tincture of the chloride of iron and oxygen inhalations. 

The arsenite of sodium and the carbonate or citrate of lithium are 
also said to be of value in this form of Bright's disease, particularly 
if it is dependent upon a gouty taint. The dose of the former should 
be -^g- grain, and of the latter 5 grains three times a day. 



BRONCHITIS, ACUTE. 

In the early stages of bronchitis there is always present a very 
distinct hyperemia, followed by a true inflammation of the mucous 
membrane lining the bronchial tubes. When these changes are con- 
fined to the larger bronchi the term bronchitis is employed, but when 
the minute bronchioles are invaded the disease is known as capillary 
bronchitis. In the article on pneumonia and elsewhere in this book, 
the writer has spoken of the various stages of inflammation, the 
measures indicated under such circumstances, and has described the 
action of the various drugs. In many cases the physician only sees 
the patient when the second stage of his disease is present, but if the 
individual presents himself at once, the following history and physical 
signs will indicate the treatment to be employed : After exposure, 
more or less severe, to wet, dampness, or dry cold, a sensation of 
oppression comes on, associated with a feeling of " tightness across 
the chest/' or a sensation as if a bolus of food was under the sternum. 
Aching and pain may then be traced over the liues of the bronchial 
tubes, while the dry hacking cough increases the discomfort and seems 
to strain the tubes till each one can be outlined on the chest wall by 
the patient. The cough, when it occurs, is virtually unproductive, 
and often hurts the larynx and throat. On making a physical ex- 
amination by auscultation there will be found over the posterior 
aspect of the chest, between the shoulder blades, sounds of bronchial 
breathing, which are rougher than normal, and due to the air passing 
over an inflamed, swollen, and roughened mucous membrane. This 
bronchial roughening may be sufficient to cause a harsh respiratory 
sound over the entire chest, and the expiratory sounds may be heard 
a little louder than usual. ~No other changes from the normal can 
be noted, but isolated spots of discomfort may be pointed out by the 
patient where aches, " catches/' or " kinks" seem to be present in a 
previously normal tube. Percussion, palpation, and inspection show 
nothing more of note. 

Some fever may be present. 

If possible, the patient is to be put to bed, and ordered, if he be 
strong and hearty and if the signs of inflammation are severe enough 



BRONCHITIS, ACUTE. 409 

to cause alarm, a full dose of pilocarpine for the production of a 
sweat, particularly if there is a great necessity for rapid cure without 
regard to the nausea which may be produced by the drug. If this 
is done no other medicine need be used, but the employment of a 
mustard foot-bath and a drink of hot brandy or whiskey and water 
should be ordered. 

If, for any reason, this treatment is not called for, and in many 
cases it will be found unnecessarily severe, the pilocarpine may be re- 
placed by full doses (2 to 4 drops) of the tincture of veratrum viride 
or a teaspoonful of the wine of antimony in adults, or J to 1 drop of 
the tincture of aconite in children, the employment of hot drinks and 
a foot-bath being also insisted upon. 

The use of antimony as a remedy in the early stages of bronchitis 
should only be resorted to when a very powerful action is required 
and the individual is very strong and sthenic. Under these circum- 
stances it may be given in full enough dose to produce marked 
nausea and even vomiting, with a profuse sweat. Along with the 
depression a profuse outpouring of liquid takes place in the bronchial 
tubes, which speedily relieves their congestion, and in consequence 
brings on the second stage of the disease in an hour or two instead 
of in two or three days. Unless some pressing need requires it, most 
persons will regard this remedy as worse than the disease. 

Counter-irritation may be applied to the chest in the shape of a 
mustard or spice plaster, or dry cups may be employed, several on 
each side of the vertebral column, at about the sixth rib. If the sore- 
ness of the bronchial tubes is not relieved by this means, inhalations 
of steam arising from boiling water placed before the patient may be 
practised, either through a cone covering the top of a pitcher and the 
mouth and nose of the patient, or by covering the head and pitcher 
with a towel. The usefulness of this method may be much increased 
by the addition of one tablespoonful of compound tincture of benzoin 
to each pint of water. In children, both in the first stage of bronchitis 
and in the later stages, the use of the so-called " bronchitis tent " is of 
great value. It consists of a canopy raised over the bed a sufficient 
distance to allow of the circulation of plenty of air. Through one side 
of this canopy passes a tube leading from a tin pail or kettle of boiling 
water, under which is an alcohol lamp to keep the temperature of the 
water sufficiently high. By this means the air breathed by the child 
is so saturated with moisture that the mucous membrane lining the 
air-passages is soothed and quieted. In order that the full benefit of 
this measure be understood, it must be remembered that a mucous 
membrane in the early stages of inflammation is always dry and red, 
lacking its normal moisture, and that the upper air-passages fail to 
catch upon their surfaces, by reason of their dryness, particles of dust, 
and do not moisten the air before it reaches the lungs. Again, it will 
be remembered that the bronchial mucous membrane is covered with 
ciliated epithelium which, by the constant upward wavy motion of its 
cilia, urges out of the lung all impurities. Dryness of the surface at 
once stops this ciliated movement with unfavorable results. The em- 



410 DISEASES. 

ployment of the "bronchitis" tent is equally useful in adults, but less 
readily employed owing to the size of the bed. 

Poultices may be applied to the chest, and while the cardiac sedatives 
are acting, resort should be had to ipecac and to citrate or acetate of 
potassium, which act as sedatives to the inflamed mucous membranes 
and aid in the formation of secretion, moistening the inflamed surfaces 
and thereby overcoming the dryness and irritation. The potassium 
salts also act as febrifuges and should be used in full doses, as much 
as 40 grains to 1 drachm in a day, in addition to the aconite already 
recommended. The following prescription illustrates their employ- 
ment : 

R. — Syrupi ipecac f ^j vel f giij. 

Potassii citratis .... ^iv. 

Aquse destillat q. s. ad f ^vj. M. 

S. — Dessertspoonful every four hours for a child of five years. 

° r > 

K. — Syrupi ipecac f/sij- 

Succi limonis . . . . . . f ^j. 

Potassii carbonatis . . . . . ^iv. 

Spirit, aether, nitrosi . . . . . f jfj. 

Aquse destillat q. s. ad f §vj. M. 

S. — Dessertspoonful every four hours for an adult. This mixture should not be 
corked for some time after it is made. 

For a child this prescription should be reduced just one half in 
each part with the exception of the water. 

In some cases, particularly if the patient be a child, large doses of 
the citrate, or other salt of potassium, exert a depressing influence and 
have to be decreased. 

When fever is persistent, quinine should be used, in addition to the 
aconite already recommended, and if the cough is excessive and annoy- 
* n & T4 ^° tV g ram of morphine may be given in each dose of the 
solution just named, or a few drops of the spirit of chloroform may 
be added to the prescription. 

Having considered the treatment of the first stage of bronchitis, 
we pass to that of the second. The condition of the mucous mem- 
branes is now quite different from that which we have just been 
speaking of. In the place of an absolute lack of secretion we have 
a profusion of cast-off epithelial cells, a large amount of mucus, and 
more or less liquid poured out upon the walls of the bronchial tubes, 
forming obstructions everywhere to the ready passage of air. The 
secretion is apt to be more or less viscid, ropy, and when it is coughed 
up, after considerable effort, appears in lumps. This state is one in 
which the excitement of inflammation is followed by local depression 
and an effort on the part of the tissues to rid themselves of the con- 
gestion and of the useless epithelial formations. The physical signs 
on listening to the chest are now found to. consist in a large number 
of loose rales which are distinctly wet and moist. Later they become 
markedly liquid and bubbling, and so large as to cause gurgling on 
inspiration and expiration. Sometimes they are musical or squeak- 
ing. Generally the latter signs do not come on until the case is far 



BRONCHITIS, ACUTE. 411 

advanced, and, if a cure is soon to be reached, they only last a few 
days or hours, as the mucus is so loose as to be easily coughed up 
and the lung readily cleared. 

The object of the physician is to use remedies which will, as they 
are eliminated by the parts, stimulate the bronchial tubes and increase 
the volume of liquid poured out. For this purpose the bronchitis 
tent may of course be employed, but the drugs to be used internally 
are ammonium, chiefly the chloride, and the pitches and turpentines, 
such as terebene, pyridine, 1 or even turpentine itself. Allium or garlic 
is often of great service at this time, or a little later in the course of 
the ailment. It may be used by boiling garlic in milk, or by the 
application of an onion or garlic poultice. 

In the majority of instances an ammonium mixture will be the best 
and most serviceable prescription, in one of the following forms : 

R. — Ammonii chloridi gij. 

Ext. glycyrrhiz. fluid. . . . . £ij. 

Aquae destillat q. s. ad fjiij. M. 

S. — Teaspoonful every four hours. 

Ji —Ammonii chloridi ,^ij. 

Mist, glycyrrhiz. comp. . . . . fjfiij. M. 
S. — The same dose. 

The disadvantage of the latter prescription is the presence of anti- 
mony in the compound liquorice mixture. 

If the cough is troublesome a little morphine or belladonna may be 
added, or the following be used, particularly if any signs of cardiac 
failure appear : 



M. 



In this prescription the first constituent acts particularly on the 
air-passages, the second stimulates the heart and respiration, and the 
third allays the cough, while the liquorice covers the salty taste of the 
ammonium. Ammonium chloride may be also used by means of the 
steam atomizer or by inhalation of its fumes by the use of some of the 
apparatus used for this purpose. In obstinate cases the inhalations of 
the fumes from chloride of ammonium may be very necessary. These 
may be obtained by attaching a long piece of rubber tubing to one 
end of a glass tube about one and a half inches in diameter and 
placing in the centre of this tube a drachm or two of sal ammoniac, 
the tube being placed in a horizontal position, each end resting on a 
thick book or other support. The open end of the glass tube is lightly 
packed with cotton and a small alcohol lamp passed backward and 

1 Pyridine, not pyrodine, is used by placing 1 fluidrachm on a hot shovel or sauce- 
pan in a small room, the patient breathing the fumes which are carried to him by 
the air of the apartment. 



. — Ammonii chloridi 


• 3J- 


Ammonii carbonatis . . 


3J- 


Ammonii bromidi . 


• 3j- 


Extract, glycyrrhiz fluid. 


^iv. 


Aquse destillat. 


• • • fgvj. 


rtspoonful every few hours. 





412 DISEASES. 

forward under the tube where the ammonium salt is lying. The 
patient may now gently inhale through the rubber tubing, and take 
the fumes which are set free directly into the air-passages. 

A very simple and ready way of using this salt without apparatus 
is to place a few grains of it in an iron spoon and heat the drug over 
a gas jet, the fumes being inhaled when the spoon becomes well heated. 
(See article on Ammonium Chloride.) 

The use of an oro-nasal respirator, with the sponge saturated with 
equal parts of terebene, iodide of ethyl and chloroform may be worn 
in order to allay cough and loosen the mucus. 

Counter-irritation may do good at this stage, particularly if applied 
over some aching bronchus, and a blister or plaster maybe employed, 
or even a dry cup resorted to. If the administration of the chloride 
of ammonium does not aid in the expulsion and liquefaction of the 
secretion, and rid the lungs rapidly of the mucus, the use of terebene 
in 5 or 10-minim capsules may be resorted to with great success. If 
capsules cannot be supplied, terebene may be made into an emulsion 
with acacia or tragacanth and given in this way. Sometimes terebene 
will irritate the kidneys and produce a sense of weight across the 
loins ; if this occurs its use should be stopped. In other cases it 
will disorder the stomach or cause diarrhoea. These effects are not, 
however, commonly seen. Terpine hydrate in 10-grain doses may 
be used three times a day, or terpinol in the dose of 8 to 10 grains 
in capsules or pills. Certain of the volatile oils and resins are also 
of value at this time, notably the oleoresiri of cubebs and copaiba, 
which, however, possess the disadvantages of disordering the stomach. 
The oil of eucalyptus is also of great value, and may be given in 
capsule or emulsion in the dose of from 1 to 5 drops every five hours. 
The oil of sandalwood in the dose of 5 to 10 minims is very valuable 
and is not so apt to disorder the stomach, bowels, and kidneys as are 
some of the other remedies named. The balsam of Peru and Tolu 
may be used, but ought always to be combined with other more active 
drugs. Apomorphine has been highly recommended in the subacute 
stage of bronchitis as an expectorant for the purpose of loosening the 
phlegm and increasing secretion. The dose should be from y 1 ^- to j- 
grain by the mouth to an adult, three times a day, under such circum- 
stances. Squill has had a very good reputation in this stage of 
bronchitis, but is a very poor remedy as compared to most of those 
now in use, irritating the stomach and kidneys and acting compara- 
tively slightly on the diseased area. 

While the proper use of these remedies usually brings about the 
results desired, in others a stage of profuse secretion comes on, which 
in its treatment is identical with that seen in chronic bronchitis, chronic 
" winter cough/' and emphysema, and these diseases will therefore 
be considered together. 

In old persons suffering from dilated bronchial tubes, from emphy- 
sema, and from chronic bronchitis, there is constantly poured into the 
air-passages so free a secretion that persistent coughing is necessary to 
rid the lung of enough of the mucus and liquid to enable the man to 



BRONCHITIS, ACUTE. 413 

breathe. Any excess of this exudation drowns him in his own 
secretions, and the constant obstruction to the ready flow of air and 
blood in the lung soon produces dilatation and weakness of the right 
side of the heart. The same condition in a more acute form some- 
times asserts itself in young children and in adults. In children it 
sometimes comes on so suddeuly as to be known as " acute suffo- 
cative catarrh," while in older persons it appears with sufficient 
severity to make the condition of the patient most serious. Of the 
treatment of this state the writer will speak at once. 

The objects desired are to rid the lung of the liquid secretions, to pre- 
vent the outpouring of more exudations, and to support the patient until 
the crisis is past. Where the exudations rapidly fill the lung, nothing 
is better in the strong child or adult than an active emetic, such as 
apomorphine, hypodermically, in the dose of -^ grain to an adult, or 
2V to a child, which is not to be repeated ; if this dose fails to act in 
ten minutes, ipecac may be used instead in the form of the powder, 
a small teaspooful for a man or 5 to 10 grains for a child, or, if the 
powder be not at hand, a wineglassful of the wine or syrup of ipecac 
to an adult or two teaspoonfuls to a child may be given. Digitalis 
should be administered to support the heart, and strychnine be em- 
ployed in full dose to stimulate the respiratory centre and excite the 
nervous system, which is generally depressed by the increasing carbonic 
acid in the blood. For the same purpose caffeine or strong coffee may 
be used. Oxygen may be inhaled and astringent sprays drawn into 
the air-passages, containing tannic acid, MonsePs solution, or other 
astringents such as shall be mentioned below. If death seems 
at hand, hot and cold dashes of water may revive the patient suffi- 
ciently to keep up respiratory movements until voluntary efforts are 
made once more by the patient. The alternate use of hot and cold 
water is necessary for the exaggeration of peripheral sensation, and 
the hot water aids in preserving the bodily temperature. Sometimes 
letting the patient hang his head over the bed when he coughs may 
aid in the expulsion of the liquid. 

The treatment of the more moderate condition of excessive secre- 
tion in the bronchitis of old persons, which is more slow in its pro- 
gress, but which may end as fatally as similar attacks in the young, 
is somewhat similar to that just given. Injurious results are often 
produced by the physician failing to recognize that the secretion is 
sufficiently liquid, and that ammonium and such expectorants are not 
only useless, but harmful, because they increase the quantity of these 
liquids. Under these circumstances a fine spray of a solution of 
tannic acid of the strength of from 2 to 30 grains to the ounce may 
be nsed, or of alum solution from a few grains to saturation. Mon- 
sel's solution should be employed in the dose of 10 to 15 drops to the 
ounce of water, or acetate of lead may be used in the strength of from 
1 to 15 grains to the ounce. Lobelia induces a too free secretion, and 
is contra-indicated under such circumstances. The use of opium to 
check the excessive excretion is a measure of doubtful value, as it 
checks the cough and thus causes the lung to become more rapidly 



414 DISEASES. 

filled with mucus. Belladonna, which checks secretion even more 
than opium, stimulates the respiratory centre, and is for this reason a 
doubly useful remedy. Counter-irritation may do good, and if the 
patient be strong free purgation should be resorted to. Strychnine is, 
however, the best of all remedies to help the patient to get rid of the 
sputum. It should be given in the dose of fa grain or more three 
times a day. 

In those cases where dilatation of the tubes is present in old per- 
sons, Calabar bean, in the form of the tincture or extract of phy- 
sostigma, is of service, owing to its action, as a tonic, on the muscular 
fibres of the walls of the tubes, preventing further bronchial dilata- 
tion and aiding in the expulsion of the secretion as rapidly as it is 
formed. 

The use of remedies designed to allay the cough in these cases is 
absolutely unjustifiable. The question as to whether the cough is ex- 
cessive or not must depend on the ability of the lung to rid itself of 
the secretions in its bronchial tubes. 



BURNS AND SCALDS. 

The treatment of burns and scalds is both internal and external, 
the first being devoted to the quieting of the nervous system after the 
injury, the relief of pain and the treatment of shock, and the second 
to the care of the injured surfaces. Immediately upon being called 
to a case of burn, it is the duty of the physician to determine how 
badly shocked the patient is, what the condition of the pulse may be 
and whether or not the lungs and air-passages are involved. After 
these mental notes, he should give a hypodermic injection of J to J- 
grain of morphine and -fa of atropine, and then roll the entire body 
in a large quilt to maintain the bodily heat while the sufferer is being 
transferred to the hospital, or the house to which he belongs. 

In some cases the shock is so great that the pulse flags at once, the 
temperature fails, and collapse ensues. Stimulants hypodermically, 
external heat, and warm drinks of water and whiskey are indicated, 
followed by digitalis if the circulation does not respond to the less 
powerful stimulants. 

If time and ciru instances permit, the dressings should be applied 
before moving the patient, but this is rarely possible. By far the 
best dressing is lint, wrung out of a mixture of linseed oil and lime- 
water, equal parts, or, if desired, the oil may be rendered antiseptic 
by the addition thereto of 1 part of carbolic acid to 20. This mixture 
is also of service in that it acts as a feeble local anaesthetic. The 
cloths should be renewed every twelve or twenty-four hours, as may 
be needed, or they may be substituted by lint wrung out of a saturated 
watery solution of boric acid. 

If the burn is not very diffuse a solution of the tincture of can- 
tharides, 1 part to 40, upon a rag, is said to relieve pain and aid in 
healing, but if the burned surface be extensive this treatment cannot 



CHANCROID. 415 

be resorted to, owing to possible irritation of the kidneys, which are 
already overtaxed by the interference with the function of the skin. 
In comparatively small burns a saturated solution of carbonate of 
sodium (washing soda) often does great good in relieving the pain. 
This relief may depend on the solvent power of this salt over albu- 
minous deposits, formed by the heat, which irritate the peripheral 
nerves. 

A large number of other remedies have been and can be used, but 
are no better than those named, and less generally employed. 

A very important point in the subsequent treatment of burns is the 
remembrance of the close relationship existing between the internal 
organs, particularly the duodenum and the kidneys, and the cuticle. 
When we recollect that we try to influence internal congestions, such 
as pulmonary congestion for example, by the application of irritation 
to the skin of the chest, we see at once that a widespread and severe 
burn is practically a huge counter-irritant and must affect the viscera. 

Again, the skin, being prevented from exhaling impurities, forces 
the kidneys to do the work, and, if the kidneys fail under the strain, 
death results. Whenever the urine is high colored and cloudy, the 
citrate of potassium should be freely given, 20 grains in water three 
times a day, combined with 30 drops of sweet spirit of nitre. 



CHANCROID. 

The chancroid is a contagious, non-specific ulcer, which has no 
period of incubation, is distinctly inflammatory in type, and is usually 
multiple. It is further distinguished from the primary sore of syph- 
ilis by the fact that it is auto-inoculable, is not followed by secondary 
eruptions, and, if it involves the lymphatics at all, produces a mono- 
ganglionic unilateral swelling, which frequently attains a considerable 
size and suppurates. 

Chancroid, being a purely local affection, would seem to require 
nothing beyond local treatment ; this is true of the uncomplicated sore, 
but where phagedena or serpiginous ulceration sets in, the question of 
constitutional treatment is of paramount importance. 

The treatment of uncomplicated chancroid is as simple as it is effi- 
cient. One thorough cauterization converts the sore into a healthy 
ulcer, the cicatrization of which is quickly and surely accomplished. 

As the most efficient means of thoroughly destroying the chancroidal 
ulcerations, the actual cautery is chiefly commended. Tins is, how- 
ever, objectionable to patients. Sulphuric or nitric acid will be found 
equally serviceable. The pain of their application may be greatly less- 
ened by the previous employment of a 20 per cent, solution of cocaine. 
When the surface involved is large the patient should be etherized. 
The cardinal point in the cauterization of chancroids is to reach and 
destroy all the diseased area. Every pocket and sinus must be thor- 
oughly acted upon, otherwise it remains as a focus for re-infection. 
A convenient way of both destroying the chancroid and providing for 



416 DISEASES. 

the after-dressing is offered in the application of Ricord's paste. This 
is made by adding to finely powdered charcoal enough strong sulphuric 
acid to form a paste of about the consistency of castor oil. This is 
then applied to every portion of the ulcer. The acid shortly dries 
out, leaving a dressing of charcoal which in a few days drops off, ex- 
posing a healthy, nearly healed, granulating surface. Where nitric 
acid is applied the subsequent dressing consists, preferably, in the 
application of dusting powders, iodoform being the best. 

There has been a tendency of late years to substitute for this treat- 
ment oue less radical, more acceptable to the patient, and in many 
cases almost equally satisfactory in results. It is certainly true that 
many of the chancroids as found in persons of robust health show little 
tendency to spread beyond comparatively narrow limits, and are 
amenable to mild treatment. It must be remembered, however, that, 
as long as the smallest portion of such an ulcer remains unhealed, it 
may, at any time, take on all the features of a virulent ulceration. 
Moreover, the patient is constantly exposed to the risks of a chan- 
croidal bubo — a complication so troublesome that the possibility of its 
development constitutes the strongest argument against palliative 
treatment. 

Where the ulceration is entirely superficial, constituting the erosive 
form of chancroid, iodoform, dusted over the surface of the carefully 
cleansed granulations, offers the best form of palliative treatment. As 
a cleansing and stimulating wash, to precede the application of the 
iodoform, 1 drachm of nitric acid to the pint of water is most satisfac- 
tory. The objection to iodoform lies in its disagreeable and penetrating 
odor. To prevent this, great care should be exercised in applying the 
powder to see that none is distributed elsewhere than upon the sore. 
The odor can also be disguised to some extent by thoroughly mixing 
with the iodoform a small quantity of one of the essential oils, such as 
oil of peppermint or attar of roses, using not over 5 minims to 1 drachm 
of the powder. There is no dusting powder which can entirely take 
the place of iodoform, yet when the objections to the use of the latter 
are insuperable aristol or iodol may be substituted, or a mixture of 1 
drachm of zinc oxide and 3 drachms of subnitrate of bismuth, or equal 
parts of calomel and bismuth. Where the discharge is profuse, pow- 
dered tannin may be combined with the dusting powder in the propor- 
tion of one part to four. 

In the ordinary uncomplicated chancroid these dry dressings are 
greatly to be preferred to wet applications ; when, however, the sore 
is attacked by a high grade of inflammation, and becomes indurated, 
prolonged immersion of the part involved, or of the whole body, in 
hot water may be followed by the application of dressings kept con- 
stantly wet with the dilute nitric-acid lotion, as given above, or with 
weak carbolic solution, 5 grains to the ounce of water, or with lead- 
water and laudanum. Where the chancroid assumes the phagedenic 
type, extending with great rapidity and causing extensive sloughing 
and destruction of tissue, free cauterization, either with the hot iron 
or by means of nitric acid, should be instituted immediately, every 



CHOLERA, ASIATIC. 417 

portion of the ulcerating surface being thoroughly destroyed. • This 
should be followed by prolonged hot sitz-baths or general warm baths, 
the patient remaining in the water for days at a time, if necessary, 
and, if practicable, eating and sleeping with the body still immersed. 
If this is not possible, baths of from two to four hours' duration should 
be given two or three times daily. After cauterization, powdered iodo- 
form is the best local application in phagedenic cases. In addition 
the patient may be given full doses of opium, and should receive a 
tonic and supporting treatment. 

Should the chancroid assume the serpiginous type, slowly extending 
in spite of treatment, till, in the course of months or years, large areas 
are destroyed by the process, the warm bath, continued night and day 
for weeks at a time, together with thorough cauterization of the entire 
diseased surface with the hot iron, represents the most satisfactory 
methods of treatment. 

The chancroidal bubo is best avoided by prompt and thorough 
cauterization of the sore ; when it occurs, however, it should be first 
treated by rest, pressure, and counter-irritation, since it may be a 
simple inflammatory adenitis, and, with care, may not run on to 
suppuration. Iodine may be painted around the swollen area, the 
patient should be put to bed, and a compress, together with a spica 
bandage of the groin, should be applied, or this may be substituted 
by a hot bag placed upon the inflamed gland. At the first sign of 
suppuration the bubo should be opened freely, should be washed out 
with bichloride solution, 1 to 1000, peroxide of hydrogen, half 
strength, or chloride of zinc, 40 grains to the ounce of water, and 
should be packed with iodoform gauze. If the bubo takes on phag- 
edenic action it should be treated precisely as the phagedenic chancroid. 



CHOLERA, ASIATIC. 

The treatment of this exceedingly dangerous disease is prophylactic, 
curative, and convalescent. 

The first measures consist of strict quarantine, both public and 
private, the avoidance of all water for culinary purposes which has 
not been boiled at least an hour and cooled in a place devoid of 
germs, and the employment of those foods which, while preserving 
the normal bodily health, in no way predispose to intestinal dis- 
turbances, as do some of the fruits, as melons and grapes. If these 
things are attended to, little remains to be done ; but it is worthy of 
remark that sulphuric acid, perhaps by its anti-diarrhceic influence, 
is a drug which is harmless in itself, yet apparently one which is pos- 
sessed of distinct prophylactic power in this disease. 

The treatment of the attack itself is supportive, and directed to 
the curtailment and modification of the symptoms shown. Above 
all things the diarrhoea must be controlled, if this is possible, since 
it saps the strength and induces the collapse which ends in death. 
To this end 10 drops of aromatic sulphuric acid may be given every 

27 



418 DISEASES. 

two hours and it may be accompanied by 5 or 10 drops of the strong 
spirit of camphor and 20 drops of laudanum until constitutional 
symptoms prohibit the further use of the opiate. If the vomiting 
is too severe to permit of the use of the laudanum by the mouth, 
morphine should be given hypodermically, and it is to be remem- 
bered that this treatment may be resorted to even in the stage of 
collapse. Sometimes the spirit of chloroform in 5 to 10-drop doses 
every hour is of great service. The fact that the purging must be 
constautly decreasing the liquids in the tissues, thereby altering the 
constitution of the blood, renders it evident that some means must 
be taken to replace the salts and water lost. For this purpose large 
draughts of water are to be employed, and, if possible, the following 
salts should be placed in it, the proportions being 100 parts of a satu- 
rated solution of tribasic phosphate of lime and 5 parts of a 1 per 
cent, solution of potassium chloride. This fluid is very nearly iden- 
tical with the blood physiologically, and may also be used intra- 
venously with great success in place of defibrinated blood, to which 
it should always be preferred. No food must be given by the mouth 
during an attack if it can be avoided, but nourishment is to be adminis- 
tered chiefly by way of the rectum, using predigested milk or beef-broth. 
Friction of the arms and legs as well as of the trunk is often a comfort, 
and the use of hot broths tends to put off the algid stage. The preserva- 
tion of the bodily heat by every means in our power is a more important 
point as the disease progresses. To control the vomiting small doses of 
cocaine may be employed and a turpentine stupe applied to the belly. 

Very extraordinary results are said by Italian observers to follow 
the rectal injection of a solution of common salt in the proportion of 
1 drachm to the pint of warm water. In other instances the use of 
tannic acid in the strength of from 1 to 8 drachms to the pint of 
water has proved very satisfactory. The amount used at each injec- 
tion should be about 2 quarts and the injection made as gently as 
possible in order to urge the fluid high into the bowel. The inflow 
tube should be a soft female catheter and the overflow tube twice 
as large as the inflow tube. The tubes are to be inserted side by side 
after thorough oiling. The injection may be used every two hours 
and continued till the outflow is clear. This is done to wash out 
poisonous materials and to supply liquid to the system. A solution 
much stronger or weaker than that named is dangerous for similar 
reasons to those given under the head of Dropsy and Saline Purgatives. 

Another useful measure is hypodermoklysis, or the passage of a 
solution similar to that just named into the subcutaneous tissues. of 
the thigh or belly wall. If done slowly these injections are absorbed 
readily and supply liquid to the depleted bloodvessels. 

Very recently Harkin has written in high praise of the so-called 
" vagus treatment " of cholera, and has recorded cases in his own and 
others' practice which reached brilliant cures by the use of a fly-blister 
over the course of the vagus nerve on both sides of the neck, just 
beneath the angle of the lower jaw. The explanation of this treatment 
rests in the belief that cholera is dependent upon some impairment of 
the functions of this nerve in the abdomen. 



CHOLERA INFANTUM. 419 



CHOLERA INFANTUM. 



Cholera Infantum is a term often applied to all the forms of active 
serous diarrhoea afflicting children in the summer months, whether its 
cause be exposure to high heat, the use of bad food, or both. In reality 
the term should be applied to that form of serous diarrhoea in which heat 
is the most common cause, and in which symptoms of lowered vitality 
and collapse rapidly come on with coldness of the extremities, pinched 
face, and wrinkled skiu. The treatment by the use of drugs is iden- 
tical in all forms of serous diarrhoea in children so far as the purging 
is concerned, but the removal of the cause requires greater care in its 
discovery and more skill in its cure. 

In cities where the heat is often great, the air damp and impure, 
and the food not always fresh, cholera infantum often appears as a 
form of thermic fever or heat-exhaustion, or, in other words, as sun- 
stroke. In these cases the temperature in the rectum will be found 
febrile, while that of the axilla is below normal, and as pyrexia does 
harm to the internal organs the internal temperature must be lowered 
by cool drinks, pieces of ice, and the careful use of antipyretics. 
The diarrhoea in this case is dependent upon a relaxation of the 
bloodvessel walls in the intestine by reason of the influence of the 
high heat upon the splanchnic nerves, and may also be partly due to 
irritant matters derived from food, or result from defective secretion 
of the digestive juices. If the thermometer placed high up in the 
rectum shows a subnormal temperature, heat-exhaustion is present, 
not thermic fever, and the treatment is reversed : Hot drinks are to 
be used, external heat applied, and friction of the limbs resorted 
to, or the child may be put in a hot bath at a temperature of 105° 
F., its temperature being carefully watched lest it rise suddenly to 
above the normal. Vomiting is nearly always a prominent symptom 
in cases of cholera infantum, and it is best under all circumstances to 
use predigested milk in teaspoonful doses every fifteen or twenty min- 
utes. If vomiting is active and collapse is threatened, a few drops of 
good brandy should be used in each teaspoonful of nourishment.! i^flp 

There is another form of cholera infantum which is not due to a high 
atmospheric temperature alone, but more commonly to the ingestion of 
irritant foods or foods unsuited to a child, obtained by the patient sur- 
reptitiously or through the ignorance of the parents. If there is such 
a history, and some of the masses of undigested food have been passed, 
a purgative dose of castor oil (1 to 2 teaspoon fuls to a child of two 
years), with 20 drops of paregoric, should be used to sweep out the 
offending materials and allay irritation, and be followed at once by 
the treatment which will be spoken of in a moment. Care, of course, 
should be taken to maintain the bodily heat, or lower it if it is above 
the normal, and a watch must be kept upon the pulse and breathing 
to note any changes requiring stimulants. 

Clinically, there is still another class of cases. The physician will be 
called to see a child with a history much like that just described. There 



420 DISEASES. 

will be the same history of indigestible food or of curds in the move- 
ments of the bowels. Careful examination will show that there is much 
bearing down, or in other cases a simple running off of the liquid from 
the bowel almost without effort. Very soon indeed the passages become 
entirely colorless, except for a speck or two of green, which shows the 
presence of the peculiar microorganism which produces this color. 
The diapers have a peculiar mousy odor, and are characteristic — that 
is, they seem to be only wet and odoriferous, and to contain no solid 
matter. If close attention is paid to them they will be seen to be 
soiled by a small amount of a white pasty -looking substance, looking 
like a paste made of water and fine chalk. Such a passage bodes ill 
for the child, unless treatment is instituted at once. The physician 
should order at once ^ grain of podophyllin for a child of six months, 
to be taken in 2 doses half an hour apart. Two hours after this the 
dose should be repeated, and again in two hours more, if necessary. 
By the end of the fourth hour there will be generally seen in the 
movements of the bowels a trace of color, and this will gradually be- 
come more marked if the case is to have a favorable termination. 

As soon as the movements have changed from the pasty-white 
motions named to those having a bilious color, then, and not till then, 
are astringents to be employed. If they are used before this the 
diarrhoea may become less for a few hours, but the child absorbs 
poisons from its alimentary canal, and rapidly goes into collapse. 

The rationale of this treatment rests upon the fact that owing to 
the disease process, every gland connected with the alimentary canal 
has become inactive through the influence of the microorganisms of 
the disease. It is absolutely necessary to bring about glandular 
activity, and podophyllin, in the experience of the author, is the best 
remedy for this state. During the period that the podophyllin is 
acting it is well to apply a spice plaster to the belly or to immerse the 
child in a hot bath to preserve its bodily temperature. 

It is of the utmost importance to stop all milk feeding at this time. 
Nothing in the way of food may be given except Valentine's or 
Wyeth's beef-juice, 10 drops every two hours in a little cold water. 

A remedial measure carried out with great success in cities in the 
treatment of cholera infantum is the use of irrigation of the bowels, 
or rather washing out the colon. This is accomplished by the use of 
the solution named in the article on Cholera. The inflow tube should 
be of soft rubber, like a female catheter. The outflow tube should be 
larger in order to carry off flakes of food or mucus. They may be 
inserted side by side after being oiled. The pressure used should be 
by a fountain syringe raised not more thau three feet above the but- 
tocks, and the outflow should be clear and unobstructed. The irriga- 
tion may be resorted to every hour or two and continued until the 
fluid flows away clear. The solution should, of course, not be too 
cold or too hot, say 100° F. 

After these measures have been resorted to, and the chief object — 
namely, a colored stool, not green — obtained, the diarrhoea must be 
stopped at once to prevent the depletion of the tissues. The medicinal 



CHOLERA INFANTUM. 



421 



treatment should consist in the use of a mixture such as the following, 

for a child of a year or eighteen mouths : 

R. — Acid, sulph aromat 

Tr. opii camphorat. ..... 

Elixir, curagoee 

Aquae cinnamomi . . . q. s. ad 



gtt. XXIV. 

fgiij. M. 



S. — Teaspoonful every two hours in water. 



Or, 



ii . — Acid, sulph. aromat. 
01. caryophylli . 
Tr. opii camphorat. 
Spirit, chloroformi 
Syr. zingiberis 
-Teaspoonful every two hours. 



s. ad 



gtt. xxiv. 

KTLviij. • 

f 3J- , ... 

gtt. xlvnj. 
fjiij. M. 



If preferred, the tincture of kino, or compound tincture of catechu, 
may be substituted for the oil of cloves or the spirit of chloroform, 
or again, the fluid extract of hsematoxylou may be taken in the place 
of either of these. 

Where the vomiting is very severe and incessant, the purging 
profuse, ill-smelling and mouse-like in odor, a rectal injection of 
starch-water, 3 ounces, containing 10 drops of laudanum, is to be 
employed, and at the same time ^ of a grain of gray powder (hydrar- 
gyrum cum creta) given every hour. The gray powder may be 
substituted by ^ of a grain doses of calomel. Very minute doses 
of arsenic given by means of the following solution are often of ser- 
vice in checking the vomiting and purging, and should be resorted to 
if necessary : 

R. — Liq. potas. arsenitis .... gtt. j vel ij. 

Aquae cinnamomi . . . . ^j. M. 

S. — Teaspoonful every fifteen minutes until four teaspoonfuls are taken. 

In still other cases the remedies named above only stop the diarrhoea 
for the time being, and it returns as soon as they are withdrawn. In 
such a case the following is of value to restore the lost tone of the 
parts involved : 

R . — Kesinse podophylli gr. J. 

Liq. potas. arsenit. . . . gtt. iij vel vj . 

Liquor calcis . . . . . . f^iij. M. 

S. — Teaspoonful every five hours. Shake well before using. 

Or a powder may be used : 

R. — Resinse podophylli gr. t- 

Pulv. ipecac. . . . . . gr. j. 

Sacchar. lact. ...... gr. xx. M. 

Ft. in chart, no. x. S. — One powder every five hours. 

A very important, never-to-be-forgotten measure in cholera infan- 
tum is the use of counter-irritation over the belly by means of a mus- 
tard plaster (1 part mustard flour to 4 of wheat flour) or by a spice 
plaster. The plaster should be renewed as often as it cools, and kept 
on continuously if the skin will stand it. 



422 DISEASES. 



CHOLERA MORBUS. 

This acute, painful, rapidly exhausting disease arises from exposure 
to cold, the ingestion of poisonous or irritating foods, exposure to 
excessive heat, and to a number of similar causes. 

In reality it may be regarded in one instance as a gastroenteritis, 
and in another as an acute serous diarrhoea associated with much pain 
of a griping, rending character. Nothing compares to counter-irrita- 
tion for the purpose of affording relief. A large mustard or capsicum 
draft should be placed over the abdomen and allowed to remain as 
long as it can be borne. If the patient knows that he has taken irri- 
tant foods, castor oil with 15 to 20 drops of laudanum added to it, to 
prevent griping, should be employed to sweep out the offending 
masses before any other remedies are used, and be followed by an 
anti-diarrhoea mixture such as here follows : 

R. — Acid, sulph. aromat. . . . fgijvelfgiv. 

Extract, hsematoxylon ^ij. 

Spt. chloroformi f % ss. 

Syr. zingiber is . . . q. s. ad f^iij. M. 

S. — Teaspoonful every two hours. 



(See article on Diarrhoea.) 

CHLOROSIS. 

(See Anjemia.) 

CHOREA. 

St. Vitus's Dance is a nervous affection, generally occurring in chil- 
dren, yielding to treatment quite readily in some cases and in others 
remaining persistently severe, and even becoming worse under the 
physician's care. 

The disease is always to be treated by the removal of all sources 
of reflex irritation, such as worms, a long prepuce if it is irritated by 
retained urine or smegma, or other trouble of this character, and in 
the avoidance of punishment or severe rebuke on the part of the attend- 
ants. Except in that form of the disease closely associated with or 
dependent upon rheumatism, the profession universally employ arsenic 
in one of its forms as a specific remedy. Generally Fowler's solution 
is used, and unless the parents are intelligent enough to drop medicine 
carefully from a bottle or dropper, the physician should order a three- 
ounce mixture, with 48 drops of Fowler's solution, so that each tea- 
spoonful will contain two drops of the drug. Very frequently, to be 
effective, arsenic must be used in ascending doses, increased one drop a 
day, and, in consequence the dilution just spoken of has to be avoided 
and the importance of care in measurement urged upon the patient's 
relatives. 



CHOROIDITIS. 423 

Whenever arsenic is used, the physician should instruct the attend- 
ants to stop administering the drug if any puffiness under the eyes is 
seen in the morning on arising from bed, or if any pain in the bowels 
ensues, as these symptoms show that the full medicinal action of the 
drug is being felt. 

When arsenic fails, cimicifuga in the dose of 20 to 30 drops of a 
fresh fluid extract to a child of ten years, may be used as the next best 
remedy. 

Where the disease is associated with rheumatism, near or remote, 
the salicylates or iodides may be of value, and should be thoroughly 
tried. 

In some cases of chorea the muscular jerkings are so severe that 
sleep is impossible aud the patient has to be held in bed and the bed- 
covers tied down. These cases will often obtain a quiet night by the 
use of the hot pack at bed-time. (See Heat.) The child should be 
placed in a blanket previously dipped in water as hot as can be borne 
by the patient and thoroughly wrapped up in another dry blauket, to 
retain the heat, and then be allowed to sweat. Care must be taken that 
a heat-stroke does not result, and, if sweating does not come on and 
oppression ensues, the blanket must be removed. The sheets should 
be iroued to have them warm for the patient when he is returned to 
bed, and it is often better to let him sleep between dry blankets. 
The efficacy of this treatment is largely increased by the use of a dose 
of bromide of sodium or potassium and a little chloral, as follows : 

R. — Chloralis £ij. 

Sodii bromid ,^ss. 

Aquae dest q. s. ad f^iij. M. 

S. — A teaspoonful in water every five hours for three doses. 

The nitrate and oxide of silver have been largely used in chorea, 
but are not reliable remedies in this disease. The dose of the first 
should be | to ^ grain, and of the second ^ to \ grain in pill form. 



CHOROIDITIS. 

Choroiditis, or inflammation of the choroid, is revealed ouly by 
ophthalmoscopic examination, and may consist merely of increased 
vascularity, of cloudiness due to serous effusion, or of yellowish-white 
patches surrounded by masses of dark pigment, indicating an atrophy 
of the choroid as well as the retina. Numerous groups and clinical 
varieties of choroiditis are described by systematic writers, but it is 
not easy in each instance to determine the cause, which may be local 
in the eye or comprise a constitutional origin like syphilis or gout. 
In the early or hypersemic stages, bleeding from the temple is ad- 
visable, and later mercury, especially in the form of the bichloride, 
or iodide of potassium may be given. The constitutional state which 
is present will indicate the suitable general medication. All use of 
the eyes should be forbidden. 



424 DISEASES. 



COLIC, HEPATIC. 

This exceedingly painful condition, due to the passage of a gall-stone 
through the bile-ducts, is always associated with faintness, nausea, and 
great agony. 

The object of the physician must be to relieve this pain, not only 
by the use of anodynes, but also by aiding in the escape of the stone 
into the bowel. To relieve the pain a hypodermic injection of mor- 
phine J to J grain, accompanied by -g 1 ^- grain of atropine, is indicated. 
The opium not only decreases the pain but allays spasm, and the bella- 
donna relaxes the spasm of the muscular coats of the ducts and allows 
the stone to pass through the relaxed passage-way. Hot applications, 
such as a turpentine stupe, may be used over the liver, but relaxation 
is not to be obtained by the use of nauseating emetics, as the retching 
or vomiting may rupture the distended gall-bladder. Severe rubbing 
should not be used for the same reason. 

Very recently the use of olive or cotton-seed oil has come largely 
into use in this affection, and while we are not sure of the means by 
which it acts, the studies of Rosenberg and others point to the chang- 
ing of the oil into glycerin and fatty acids, the first of which lique- 
fies and increases the flow of bile. The oil is used during the attack 
of pain, and must be swallowed in the dose of half a pint at least ; 
smaller quantities do not suffice. Its action may be aided and its reten- 
tion in the stomach promoted, by the addition of a drachm of ether to 
each dose. 

Shortly after the oil is swallowed, sudden relief often occurs, due 
to the escape of the stone into the bowel. The stools should then be 
carefully watched for gall-stones, but care should be taken that the 
lumps of soap which are passed, made from the oil by the alkaline 
juices in the intestines, are not mistaken for true biliary calculi. If 
the pain does not yield to morphine, chloroform or ether may be in- 
haled for the relaxation of the spasm and the relief of pain. 

The treatment of the state predisposing to the formation of hepatic 
calculi consists largely in the use of a moderate, regular diet devoid 
of much fats, wines or beers, and in the following of an out-door life. 



CONJUNCTIVITIS. 

Simple Conjunctivitis, sometimes called catarrhal, acute, or muco- 
purulent ophthalmia, is characterized by congestion of the conjunctiva, 
loss of transparency of the palpebral portion, and some dread of 
light, with a discharge, sufficient only to glue the lids in the morning 
or free and muco-purulent. In the milder stages the use of a boric 
acid lotion (10 grains to the ounce) is suitable, and the lids should be 
frequently washed with neutral soap and water ; if there be much muco- 
purulent discharge the lid should be everted and an application made 
of a solution of nitrate of silver (from 2 to 5 grains to the ounce). 



CONJUNCTIVITIS. 425 

If the discharge becomes great, bichloride of mercury, 1 to 10,000, 
may be employed with advantage, and the nitrate of silver solution 
increased to 10 grains to the ounce, the excess being neutralized 
with a solution of salt or washed away with tepid water. Much 
inflammatory reaction in this disease may be alleviated by cold com- 
presses. These are rendered more efficacious if dipped in equal parts 
of water and the extract of hamamelis. Patients suffering from 
catarrhal conjunctivitis should be protected from tobacco smoke, bright 
light, dust, or any mechanical irritant. Atropine usually is unneces- 
sary unless a corneal ulcer complicates the affection. The patient may 
wear smoked glasses, but under no circumstances must the eyes be 
bandaged or have 'poultices applied to them. Domestic medication of 
this sort may change a simple ophthalmia into a serious and purulent 
inflammation. Topical medications other than those mentioned are 
alum (4 to 8 grains to the ounce), sulphate of zinc (1 to 2 grains to 
the ounce), which may be suitably combined with boric acid, creolin, 
1 per cent, solution, and pyoktauin, 1 to 1000 ; the latter remedy, 
however, has not justified the claims which have been made for it. 
During the subsidence of the inflammation, and if it shows any 
tendency to become chronic, the application of an alum crystal, or a 
solution of tannin and glycerin (10 grains to the ounce), is suitable. 
It should be remembered that muco-purulent ophthalmia may become 
epidemic in crowded institutions, and great care should be taken to 
isolate cases. One soiled towel may be the source of infection to a 
great number of children. Constitutional treatment ordinarily is not 
required, but proper hygiene, fresh air, good food, the intelligent use 
of laxatives, tonic doses of quinine, and whatever treatment is indi- 
cated by any associated condition, are useful. The associated condi- 
tions most commonly are nasal catarrh, bronchitis, a general cold, 
eczema of the face, and the exanthemata. 

Burns of the Conjunctiva. — Immediately after the accident all 
foreign particles should be removed or neutralized with a weak acid 
or alkaline solution if a liquid caustic or acid solution has entered 
the eye ; then a few drops of cod-liver oil may be instilled and atro- 
pine employed (suitably incorporated with liquid vaseline) to prevent 
iritis. The chief danger lies in the formation of severe corneal in- 
flammation and symblepharon ; the latter may sometimes be pre- 
vented by daily breaking up the granulation tissue or by the insertion 
of a piece of gold-beater's skin between the inner surface of the lids 
and the eyeball. The associated conjunctivitis and keratitis require 
treatment differing in no way from that described in the idiopathic 
forms of these affections. 

Purulent Conjunctivitis, which is commonly seen in the adult in 
the form of gonorrheal ophthalmia, and in the infant as ophthalmia 
neonatorum, is produced in both varieties by the introduction into the 
eye of a specific virus from either the urethra or the vagina. The chief 
danger of the disorder is destruction of the vitality of the cornea and 
loss of sight. The most important indication is to prevent this danger 
by reducing the amount of swelling of the lids and conjunctiva and 



426 DISEASES. 

the profuse discharge, which are the characteristics of the disease. 
These indications are met best in the following manner : Hourly 
cleansing of the eyes with an antiseptic solution, preferably bichloride 
of mercury (1 to 8000), or a saturated solution of boric acid. During 
the acute inflammatory stage, and before the discharge is profuse, 
astringents and cauterants must not be applied. When this stage has 
arrived, and the conjunctiva is profusely covered with discharge, the 
lids should be carefully everted once a day, wiped clean of every par- 
ticle of pus, and carefully touched with a solution of nitrate of silver 
(10 to 20 grains to the ounce), and the excess neutralized with a few 
drops of a solution of common table salt. In the early stages* iced 
compresses wrung out of carbolized water and frequently changed, 
will help to reduce the reaction, or these compresses may be made by 
placing squares of lint upon a block of ice and thus securing intense 
cold. If the vitality of the cornea is threatened it is advisable, in 
many instances, to substitute for the cold applications hot compresses 
of a temperature of 110° F. These may be applied for from ten to 
twenty minutes every two or four hours, according to the exigencies 
of the case. The appearance of ulceration in the cornea calls for the 
use of atropine or eserine. Atropine was formerly employed almost 
exclusively ; in recent times great success has followed the adoption of 
eserine. This is especially applicable if the ulceration should form in 
the periphery of the cornea. In adults, high reaction and violent 
inflammation may be alleviated by the use of leeches to the temple. 
Bleeding of any sort is not applicable to newborn infants. Other ap- 
plications which have met with favor at the hands of various surgeons 
are solutions of sulpho-carbolic acid, sulphate of alum, sulphate of 
zinc, nitrate of silver, creolin (1 per cent.), and iodoform ointment. 
Both blue and yellow pyoktanin have been recommended, but do not 
yield satisfactory results. Peroxide of hydrogen is a good cleansing 
agent, but healing does not progress as favorably under its influence as 
with bichloride of mercury and nitrate of silver. Solutions of per- 
manganate of potassium, and aqua chlorini have many advocates. 
Mules has recommended a treatment with alcohol and corrosive subli- 
mate. The preventive method of treating ophthalmia neonatorum that 
has obtained the happiest results is that instituted by Cred6, namely, 
the dropping of a 2 per cent, solution of nitrate of silver into the eyes of 
the newborn infant. If one eye alone is attacked in gonorrhoeal ophthal- 
mia the other should be protected by covering it with Buller's shield, 
which consists of a watch-glass fixed in a square of plaster, which is 
carefully applied so that the crystal comes directly in front of the eye, 
and the plaster covers the surrounding area. 

Chronic Conjunctivitis may result from an antecedent acute inflam- 
mation of the conjunctiva, or exist as an idiopathic affection, especially 
in elderly people, in whom it sometimes becomes a troublesome symp- 
tom, especially if complicating cataract. The characteristic lesions are 
roughness of the papillae of the conjunctiva, swelling of the caruncle, 
and soreness of the angles of the eyelids. There are no granulations, 
although the disease is sometimes inaccurately spoken of as granular 



CONJUNCTIVITIS. 427 

lids. A soothing wash is indicated (10 grains of boric acid to the 
ounce of water) to which may be added 2 grains of cocaine, provided 
the cornea is not ulcerated, and for which a similar boric acid lotion 
with 4 grains of salt to the ounce may be substituted. A very suitable 
local application is lapis divinus (sulphate of copper one part, alum one 
part, nitrate of potassium one part, fused together, and camphor equal 
to one-fiftieth of the whole added. The mass is run into sticks and 
the application made to the everted lids, or 1 grain of the same prep- 
aration to the ounce of water may be droppod into the eye). Other 
useful applications are tannin and glycerin (10 grains to the ounce), 
yellow oxide of mercury salve, and alum crystal. If refractive error 
exist this should be corrected. It is to be remembered that chronic 
conjunctivitis distinctly contra-indicates any operative interference in 
the eye, as, for instance, cataract extraction. 

Lachrymal Conjunctivitis is a name given to a chronic form of 
inflammation of the conjunctiva, associated with obstruction in the 
lachrymal duct, and characterized by a tear-soaked appearance of the 
eye, small pustules at the roots of the lashes, and a gummy discharge 
along the palpebral margin. This can be cured only by relief of the 
stricture of the nasal duct which causes it, but may be alleviated with 
the same remedies recommended in the treatment of chronic conjunc- 
tivitis. Good results are reported from the use of pyoktanin. 

Follicular Conjunctivitis, a disease sometimes mistaken for granular 
lids, but having a distinct clinical difference, inasmuch as the swollen 
follicles are absorbed without the production of cicatricial changes in the 
conjunctiva, requires for its local treatment weak astringents and anti- 
septic lotions, and the application to the swollen follicles of an oint- 
ment of sulphate of copper (gr. J to the drachm), dusting in calomel 
either alone or with equal parts of subnitrate of bismuth, or iodoform 
or aristol used in the same way. If the disease is stubborn the swollen 
follicles should be crushed with forceps. 

This disease, or one analogous to it, is sometimes produced by the 
prolonged instillation of atropine, and less frequently by eserine and 
cocaine. If this is its cause, the drug must be suspended and the 
surface painted with an alum crystal. 

Granular Conjunctivitis. — This disease may be divided into acute 
and chronic granulations. In the former, astringents and caustics are 
inadvisable, the eyes requiring weak antiseptic solutions like boric 
acid or salicylic acid, and the instillation of atropine. Leeches to the 
temple will aid in reducing the inflammatory reaction. In the chronic 
disease the object of treatment is to bring about absorption of the 
granulations which are its characteristic lesion, not by an application 
so caustic as to destroy the mucous membrane around them, but of 
sufficient vigor to produce healthy reaction. The following applica- 
tions comprise those which have been employed with the greatest 
success : 10-grain solution of nitrate of silver, if there is discharge, 
applied once a day with neutralization of the excess ; sulphate of 
copper in the form of a crystal carefully applied to the everted lids 
and the retrotarsal folds ; pure carbolic acid applied with a camel's- 



428 DISEASES. 

hair pencil and the excess washed away with water ; glycerole of 
tannin (tannic acid grs. 30, glycerin 1 oz.) best applied with a cotton 
applicator ; boro-glyceride from 20 to 50 per cent ., according to the 
vigor of the granulations. Strong solutions of corrosive sublimate 
are employed in the following manner : solutions of the strength of 
1 to 300 or 1 to 500 are painted on the everted lids every second day, 
the pain of the application being alleviated by the previous instillation 
of cocaine, while three times daily the eyes are irrigated thoroughly 
with a solution of the mercury salt 1 to 7000. Among the many 
other applications which may be used in this disease the following 
may be mentioned : liquor potassa, beta-naphthol, iodoform or aristol 
in powder or salve, an ointment of the yellow oxide of mercury ; 
calomel and hydrastin. The surgical means which are employed to 
destroy the granulations are scarification of the conjunctiva, an inad- 
visable method ; excision of the granulations, useful if these exist in 
isolated groups; crushing the granulations with specially devised 
forceps, a method often followed by satisfactory results ; scarification, 
followed by a vigorous brushing of the affected tissue with a brush 
containing short bristles, previously dipped in a strong (1 to 500) 
solution of corrosive sublimate (Grattage) ; and excision of the fornix 
conjunctiva. In long-standing cases associated with inveterate pannus, 
De Wecker has proposed the use of an infusion of jequirity (3 per 
cent.). This produces an intense membranous conjunctivitis, which 
must be treated by iced compresses or similar measures to reduce its 
reaction, but when it has subsided the pannus is often relieved. This 
method has not been employed in recent times to the extent that it was 
practised when first introduced. 

Diphtheritic Conjunctivitis is rare in this country, but on the con- 
tinent of Europe occasionally occurs as an epidemic. It may appear 
alone or in association with diphtheria of the throat and nose. The 
initial subjective symptoms are those of purulent ophthalmia ; the 
characteristic objective symptoms, a board-like infiltration of the lids 
with a deposit of gray membrane upon the palpebral conjunctiva. 
More than in any other eye disease destructive inflammation of the 
cornea is threatened. In the early stages the eye should be fre- 
quently cleansed with boric acid or bichloride of mercury solutions, 
and atropine instilled, while hot compresses help to maintain the nutri- 
tion of the cornea more perfectly than the cold compresses which were 
formerly recommended for antiphlogistic purposes. Tweedie has highly 
recommended a solution of quinine (3 grains to the ounce) ; Burgomaster 
insufflation of flowers of sulphur ; while in France the local application 
of lemon juice or citric acid ointment has been endorsed ; Galezowski 
uses oil of cade (1 to 10). In the early stages all caustics are contra- 
indicated ; after absorption of the membrane and reestablishment of 
the discharge the cautious use of nitrate of silver in the manner de- 
scribed under Purulent Ophthalmia may be employed. The constitu- 
tional measures for diphtheria are necessary. 

Chemosis of the Conjunctiva, in which this membrane is infiltrated 
with serum, is usually a symptom of other ocular disorders, and sub- 



CONSTIPATION. 429 

sides with the general treatment directed to their relief. Good results 
may follow nicking the swollen tissue with a pair of scissors ; the 
application of a warm, moist compress, and the use of astringents, 
especially alum. 

Haemorrhage Beneath the Conjunctiva (subconjunctival ecchymosis) 
may follow an injury, occur during a paroxysm of whooping-cough, 
and occasionally, in elderly people, may appear spontaneously. No 
treatment materially hastens the absorption of the blood unless it be 
massage of the globe through the closed lid ; any associated conjunc- 
tival irritation may call for a boric acid and cocaine wash. 

Xerosis of the Conjunctiva, depending upon a cicatricial metamor- 
phosis and the absence of normal moisture, is seen after long-standing 
inflammations (granular lids, diphtheria, pemphigus), and is incurable. 
The aifection may be relieved by the local use of glycerin, almond oil, 
emulsion of cod-liver oil, or the use of weak alkaline solutions. Trans- 
plantation of the rabbit's conjunctiva has been tried without success. 



CONSTIPATION. 

This troublesome state depends on a number of causes, the most 
common of which is the following of a sedentary life totally devoid of 
the exercise intended to keep the intestinal and hepatic secretions in an 
active state. Another frequent cause is simple laziness, which causes 
the patient to resist the call of the bowel for evacuation until this part 
of the body becomes indolent aud atonic, while modesty often causes 
constipation in females, because a woman prefers to suffer rather than 
go to a closet which may be somewhat publicly situated. In other 
instances constipation seems to be hereditary and to depend upon 
deficient nerve-supply, or muscular weakness and lack of secretion in 
the lower bowel, or to hepatic torpor. 

Whatever the causes are, they should be sought for, and, if possible, 
removed, the physician not being content to order purgatives, which, 
while they may give temporary relief, soon lose their power. 

Further than this, it must be remembered that hygieuic measures 
always take first place in the method of treatment, and, if possible, 
drugs should occupy a very secondary role. Particular attention 
should be paid to diet, and the physiology of peristalsis must be well 
borne in mind. 

It has been proved by a large number of studies, both in the normal 
intestine, and by the use of purgatives, that peristalsis is almost entirely 
a reflex action depending for its existence upon the integrity of the 
nervous plexuses in the intestinal walls, namely those of Auerbach 
and Meissner, the first of which are situated between the longitudinal 
and circular muscular fibres which they supply, the latter existing 
in the submucosa and supplying the walls of the villi, the glands of 
Lieberkuhn, and the small arteries and venules. 

It has also been found that the vagus nerve, when stimulated re- 
flexly or directly, increases peristalsis, and that moderate stimulation 



430 DISEASES. 

of the splanchnic nerves decreases it. 1 It at once becomes evident that 
any decrease in the normal activity of these nerves and nerve-centres 
must speedily result in constipation, and the costive condition conse- 
quent upon hepatic torpor is due to the fact that the intestinal walls 
do not receive the proper stimulation from the bile to set in motion a 
reflex wave the result of which will be evacuation. This fact rests 
upon the results of direct experiments which prove the bile to be pri- 
marily an intestinal stimulant, antiseptic, and promoter of secretion. 

Other series of experiments have shown that the circulation of the 
blood through the intestines greatly influences peristalsis, and disorders 
in the blood-supply readily bring on intestinal disorder. 

The deductions to be drawn from these facts are many. In the 
first place, it is evident that the maintenance of an active, normal cir- 
culation of blood in the abdomen and a free pouring-out of bile from 
the liver and gall-bladder are necessary to a healthy peristalsis, and 
we find that, aside from drugs, we have a number of remedial meas- 
ures which are to be resorted to according to the means of the patient. 
By far the best of these is horseback exercise for at least an hour a 
day, or every other day, which, by the motion, actively stirs up and 
excites the abdominal viscera as no other measure can do. If for any 
reason horseback exercise is impossible, then abdominal massage car- 
ried out by a capable masseuse is to be tried, the hands following 
more particularly the course of the ascending, transverse, and descend- 
ing colon, the kneading movements being also applied to the hypo- 
chondriac regions. If neither of these measures can be used, then the 
patient must resort to those gymnastic movements which involve the 
abdominal muscles, either by the use of dumb-bells or pulleys, such 
as are sold under the name of "home gymnasiums," or by bending 
the body forward, backward, and laterally, with the fists pressed into 
the hypogastrium. 

At the same time that these measures are directed, the diet of the 
patient must be so regulated that the food shall contain a large amount 
of residue — that is, after digestion enough of the husk of the grain or 
enough vegetable fibre must be left free in the intestines to form a 
stimulus to the intestinal wall as it slips over the mucous membrane. 
If a meat diet is largely used, so little residue is left after digestion 
that constipation ensues, but if vegetables are largely eaten the reverse 
is the case. No better evidence of this can be adduced than the hard r 
clay-like passages of the dog, and the soft passages of the cow. Very 
often a plateful of cracked wheat (wheaten grits) eaten at breakfast 
each morning, or the use of bran bread, will relieve a chronic tendency 
to constipation. In these cases milk is to be avoided above all things, 
since it is almost entirely assimilated and leaves no residue, though it 
supplants other foods. Green or canned corn is of great service. 
Fruits do good in constipation in one of two ways — they either con- 

1 Some persons believe that Meissner's plexus receives impulses from the walls of 
the intestine and transmits them to the motor plexus of Auerbach, which then sets in 
motion peristalsis. 



CONSTIPATION. 431 

tain residuous materials or sufficient vegetable-acicl salts to be laxative. 
Figs, by reason of their many small seeds, which scrape the mucous 
membraDe during peristalsis, are particularly valuable, and apples, 
prunes, dates, and tamarinds are all useful. It must be remembered 
that strawberries, raspberries, aud blackberries are generally consti- 
pating rather than purgative. Id regard to drink, nothing is so good 
as a glass of cold water taken on arising in the morning or just before 
breakfast, or, if the cold cannot be borne, then a glass of as hot water 
as can be swallowed with comfort may be substituted. Coffee is con- 
stipating to most persons, largely because of its empyreumatic oil, and 
tea has the same tendency because of its tannic acid. Brandy, as 
everyone knows, is distinctly constipating, and whiskey possesses so 
little power to the contrary as to be devoid of influence in either 
direction. Beers differ in their properties, some of them increasing 
and some of them decreasing intestinal activity. 

The patient suffering from constipation should go to stool regularly 
after breakfast every day, even if the attempt is abortive, and so train 
the bowel to expect a movement at this time. 

The use of drugs for the relief of constipation is capable of division 
into two parts : first the employment of remedies to unload the bowel, 
which has become filled; second, the use of drugs which will so influ- 
ence the intestines as to cause evacuation and produce normal activity, 
or, in other words, drugs which will cure the tendency instead of 
giving temporary relief. Of the first class we find the various pur- 
gative salts, jalap, colocynth, senna, mercury, castor oil, and rhu- 
barb; of the second class, aloes, cascara sagrada, manna, tamarinds, 
rhamnus frangula (buckthorn), phosphate of sodium and small doses 
of podophyllin. The physician should bear in mind that defsecation 
is a normal physiological act, which must be continued all through 
life, and it is almost as foolish to stimulate the bowel continuously to 
peristalsis as to perpetually employ heart stimulants or respiratory 
excitants. 

Although they are habitually employed by many persons in daily 
doses, the purgative salts are exceedingly harmful in such instances, 
rapidly losing their power and decreasing the patient's strength by the 
abstraction of liquids and salts from the blood. They often produce 
anaemia when constantly used. These salines are to be employed 
simply to unload the bowel when an excess of fsecal matter has accu- 
mulated, or when irritant materials are to be swept out of the alimen- 
tary canal. In some cases of pelvic congestion associated with con- 
stipation, magnesium sulphate may be given by enema in the propor- 
tion of 2 ounces of the salt, 1 ounce of glycerin and 4 ounces of 
water. In some rare instances, where great plethora exists, a course 
of Hunyadi water, Friedrich shall or Carlsbad waters is of service, 
but these instances are rare indeed in America. Jalap, colocynth, 
and senna are not to be used constantly, as they are too active, and 
the reaction from their effects causes constipation. Khubarb is com- 
monly used, but is of its class peculiarly unfitted to its task. Although 



432 DISEASES. 

it purges it is distinctly astringent, and is, therefore, more consti- 
pating in the end than if no drug had been used. 

Mercury is exceedingly harmful if used continuously as a purge, 
and is the cause of much ill-health, bad teeth, and digestive troubles. 
Castor oil is notorious for its tendency to cause ultimate constipation. 

Of the curative class of laxatives none compare to cascara sagrada, 
particularly in the form of the tasteless fluid extract or cascara cor- 
dial. Originally this drug as prepared was very bitter, but it is now 
made almost tasteless by certain manufacturers. This is the only 
drug which alone moves the bowels and at the same time tends to 
make future passages more easy and regular ; the dose is 10 to 20 
drops of the fluid extract, or 1 drachm to 6 of the cordial. There is 
almost no griping produced by it. For the regulation of the bowels 
of young children, particularly if the case be somewhat " rickety " in 
tendency, phosphate of sodium in the dose of 5 to 10 grains in milk 
is the best laxative, and the same salt may be used in 30 to 60-grain 
doses in adults. Manna is to be classed as a laxative fruit, but even 
it sometimes make the intestinal torpidity ultimately much worse. 
The two remaining drugs of this class, aloes and podophyllin, should 
always be used in combination with other non-purgative drugs, as is 
seen in the following formulae : 

I£. — Aloes socotrinae gr. xx vel xl. 

Extract, nucis vomicae . . . . gr. iv. 

Extract, physostig gr iij. 

Extract, belladonnse gr. iv. M. 

Ft. in pil. no. xx. S. — One pill at night or night and morning. 



Or, 

Be . — Resinae podophylli 

Extract, nucis vomica? 
Extract, physostig. 
Extract, belladonnae . 


. gr. ij vel iv. 

. gr. iv. 

. gr. iij. 

. gr. iv. M. 


Ft. in pil. no. xx. S. — One as above. 





The object of using several of these drugs is seen at a glance. We 
have already learned that nearly all purgatives tend to produce 
griping. The nux vomica acts as a bitter tonic and stimulant and 
prevents subsequent atony of the mucous membrane, as well as in- 
creases reflex action, and consequently improves peristalsis. The physo- 
stigma is a tonic to the unstriped muscular fibre and gives it strength ; 
the belladonna aids peristalsis by depressing the inhibitory fibres of 
the splanchnic nerves, by allaying spasm and by decreasing griping. 
In using these drugs, aloes and podophyllin, we should remember 
that aloes is slow and acts particularly on the lower bowel, and that 
podophyllin acts chiefly on the upper bowel and is the slowest purge 
in the list of purges. 

In the flatulence of old persons associated with constipation a little 
asafoetida or capsicum should be added to the pill of aloes just 
named. 

In some instances constipation arises from reflex irritation, or from 
ovarian or bladder trouble or from chronic lead poisoning. This form 



OOKTZA. 433 

of constipation may resist all purgatives and yield to opium or to 
tobacco, which quiet reflex action. Tobacco depresses the inhibitory 
nerves of the gut, and devotees of the " weed " often use it as a laxative. 
The employment of enemata as a routine practice is to be discour- 
aged. In cases where it is necessary to use them for temporary relief, 
and to get rid of flatulence, a little soap, common salt, or a few drops 
of turpentine may be added to the water. Recently the injection of 
glycerin (1 to 2 ounces) has been largely resorted to, either pure or 
diluted one-half, and this method has been improved upon by the 
use of glycerin suppositories containing several drops of the drug. 
Glycerin acts in these cases as an irritant to the mucous membrane 
and causes secretion by this means and by its abstraction of water 
from the tissues by reason of its hydroscopic powers. 



CORNS. 

These troublesome formations are best treated by the use of sali- 
cylic acid, the following formula being applied night and morning for 
several days, after which the part should be well soaked in hot water, 
when the entire corn will readily come away — or in some cases several 
attempts will be necessary. 

1£. — Acid, salicylic gr xxx. 

Extract cannab. indicse . . . gr. x. 

Collodii . fgss. M. 

S. — Apply with a camel' s-h air brush. 

The same acid may be used in alcohol, and lactic acid in the same 
proportion is often of service. 

In the so-called "soft corns " with much inflammation the foot 
should be washed and dried, and a saturated solution of nitrate of 
silver, 60 grains to the drachm, applied to the part every four or 
five days. 

OORYZA. 

Coryza, or ordinary cold in the head, is an acute inflammation of 
the mucous membrane of the nose — a disease of so frequent occur- 
rence during the changeable weather of the spring and winter months 
that it rarely receives the attention that it deserves. As it is in most 
cases the point of departure from health toward chronic nasal catarrh, 
its complete cure, in each instance, is a matter of importance. 

Among the causes of coryza are exposure to cold or dampness, wet 
feet, the checking of secretions, and lowering the tone of the mucous 
membranes by inhaling close or impure air. It is also caused by 
inhaling dust, acrid vapors or gases, as bromine, chromic acid, and 
pyrethrum, or Persian insect powder. 

Permanent changes occur in the nasal mucous membranes when 
the exposure to irritation is long continued. 

Hay-fever subjects are liable to attacks of coryza from very slight 

28 



434 DISEASES. 

causes during any part of the year, the susceptibility increasing, how- 
ever, as the season approaches for their periodic outbreaks. The 
exciting agent is usually in the form of dust of some kind, though 
all are not equally sensitive to the same irritant. The rose, the 
peach, the golden-rod, the rag-weed, each has its victims. The writer 
once treated a woman who could work in wheat flour with impunity, 
while the same exposure to rye flour at any season of the year pro- 
duced a violent attack of coryza with uncontrollable fits of sneezing 
and running from the eyes and nose. By removing the cause and 
retiring to a quiet, cool room these attacks would pass off in a short 
time without any other treatment. It is possible to multiply the 
description of cases of this nature, but their consideration comes 
more appropriately under the head of vasomotor disturbances and 
hay-fever. 

Coryza usually commences with a creeping sensation, with or 
without a distinct chill, followed by constitutional disturbance, as 
fever, dry, parched skin, pain and aching in the back and limbs. 
The urine is high-colored and scanty. Frontal headache varies in 
intensity from an acute lancinating pain to a dull ache or throb over 
the brow, increased by leaning forward. The nose and throat at 
first are dry and parched, the tongue literally u cleaving to the roof 
of the mouth." 

Sneezing, which may be a prominent symptom from the first, is fol- 
lowed by a profuse watery discharge from the nose and eyes. The 
erectile tissues on the turbinated bones become engorged with blood, 
producing complete obstruction to breathing. When the swelling causes 
excessive pressure, the intra-nasal tissues may become cedematous. 

Pressure to this degree, stretching the turbinated tissues and im- 
pinging upon the delicate sensory nerves of the septum, causes acute 
headache centring over the frontal sinuses or the cheek-bones, having 
a neuralgic tendency to shift its position. The eyes are injected and 
become suffused on the least exposure to light. Mild delirium may 
supervene upon pressure in the upper turbinated region, the roof of 
which, we must remember, is only separated above from the base of 
the brain by the cribriform plate of the ethmoid bone. 

The filaments of the olfactory nerve, piercing the cribriform plate 
of the ethmoid bone, are distributed to the upper turbinated and the 
upper half of the middle turbinated bones, and on the septum to 
about the same level. This region, called from its function, olfactory, 
appears in health slightly lighter in hue than the region below, which 
is mainly respiratory in function. 

A few of the reflex disturbances, resulting from changes in intra- 
nasal pressure, will be considered elsewhere. 

An intense itching of the end of the nose is, with some people, the 
first indication of an approaching cold in the head. Such persons 
usually have an abundance of stiff hairs in the orifice of the nostrils, 
and, stimulated by the extra blood-supply to their roots, these hairs 
gradually become erect, and, in doing so, tickle the already hyper- 
sensitive membrane of the vestibule of the nose. 



CORYZA. 435 

During this stage of hypersecretion the amount of watery fluid 
discharged from the nose is very great, containing in addition to the 
secretion from the mucous glands, exfoliated epithelial cells, leucocytes, 
and saline constituents from the blood. The free discharge and con- 
stant use of the handkerchief may excoriate the upper lip and the 
alse of the nostrils, adding to the general discomfort. 

The rapid draining of serum produces a degree of weakness and 
vital depression, apparently disproportionate to the severity of the 
disease, the exhaustion being indicated by loss of weight and strength, 
and by pallor. 

After a variable period the discharge becomes thicker, less copious, 
and more muco-purulent in appearance, and, under favorable con- 
ditions, completely disappears in a week or ten days, gradually 
drying up, so that the swollen mucous membranes regain their 
natural tone. 

Under less favorable conditions, as in strumous subjects, resolution 
takes place more slowly, and the discharge remains muco-purulent or 
purulent for an indefinite period. 

The tissues remain more or less thickened, leaving a permanent 
contraction of the calibre of the nostrils, with slight difficulty in 
breathing through the nose. A renewal of the cold at this time and 
increased infiltration or relaxation of the submucous connective tissue 
leave still greater obstruction. The tendency to recovery is lost, and 
the condition has become one of hypertrophic nasal catarrh. In- 
spection of the interior of the nose shows the tissues at first dry and 
red. The ends of the turbinated bones appear as puffy, red cushions. 
This congested state may extend to the vault of the pharynx and 
involve the orifices of the Eustachian tubes, and so lead to a train of 
ear symptoms. 

During the stage of secretion the membranes become very much 
swollen. The erected turbinated tissues completely close the lumen 
of the nostrils and press firmly against the septum. The same state 
exists at the back of the nose, and the tissues on the lower or middle 
turbinated bones may even project into the naso-pharynx, the whole 
interior surface being bathed with secretion, either serous or muco- 
purulent, according to the stage of the disease. The intense swelling 
makes an examination rather unsatisfactory at this period. The 
mucous membrane remains slightly reddened for some time after 
apparent recovery takes place. 

The usual method of treating cold in the head is with u contempt. 7 ' 
The patient, as a rule, takes the law into his own hands, only seeking 
medical advice when an attack of unusual severity arouses his fear of 
catarrh. 

Prompt treatment will often abort an attack of coryza, and, failing 
in this, will cause it to run a shorter and milder course. (See Iodine, 
Menthol, and Camphor.) 

When it is the result of chilling the surface of the body, a Turkish 
bath may be taken at once. Should this be inconvenient, or too 
active, a hot mustard foot-bath, with a hot draught or Dover's powder 



436 DISEASES. 

may be sufficient, with rest in bed, to bring on perspiration and a com- 
plete relief. 

Whiskey, by its power of increasing the capillary circulation of the 
skin, is a useful remedy, especially where the heart is weak. 

It has been well proved that whiskey is not equally efficient in pre- 
venting an attack, as the first glow which it produces is followed by a 
stage of depression, during which the resistance to exposure is lessened. 

The inhalation of steam charged with such volatile substances as 
camphor, cubebs or benzoin, may give relief to the congested mucous 
membranes. Quinine by its action on the nervous system often gives 
good results, and is universally employed by the laity. 

As congestions of the mucous membranes frequently result from a 
torpid liver or overloaded bowel, good results often follow from small 
doses of calomel or a blue pill, followed by a saline laxative. The 
saline purge alone, by its revulsive action, is often of benefit. Meas- 
ures to restore any suppressed secretion should be instituted at once. 

Atropine in small doses has given me excellent results, employed 
during the stage of free watery secretion. It may be combined with 
small doses of morphine, employing quinine at the same time. 

Locally, the use of a mild alkaline or antiseptic wash gives relief, 
by reducing the inflammation and cleansing the parts from secretion. 
The following, which is a modification of the well-known " DobelPs " 
solution, meets the requirements : 

&. — Acid, carbol. (cryst.) . . gr. x. vel xv. 

Sodii bicarb. \ .. ' . 

Sodii borat. / c 3J* 

Glycerini f Sjj. 

Aquse q. s. ad Oij. M. 

This solution may be used by gently drawing it up the nose, or as 
a spray from a hand atomizer. When the odor of carbolic acid is ob- 
jectionable, it may be substituted by menthol, thymol, or eucalyptol 
in very small quantity. When the membrane is too much swollen to 
admit such a spray, the local application of a 2 or 4 per cent, solution 
of cocaine will contract the tissues long enough to allow the employ- 
ment of other measures. Cocaine gives great temporary relief, but its 
too frequent use appears to increase the congestion afterward. 

The alkaline wash may with advantage be followed by the insuf- 
flation of the following anodyne powder, known as Ferrier's snuff: 

R . — Morphinse sulphatis gr- v. 

Bismuthi subnitratis . . . . gij. 

Acacise £ss. 

Fluid cosmoline sprayed into the nose, after cleansing it from 
secretions, has a soothing effect. The use of severe remedies, such as 
irritating snuffs, while they deplete the tissues by increasing the flow, 
only intensify the inflammation afterward. 

The nasal douche should be avoided in all conditions of obstruc- 
tion in the nostrils, especially in obstruction to the outflow of liquids. 
As a rule, solutions are carried into the nose more readily than from 



CROUP, SPASMODIC. 437 

it, and in such a case the hydraulic pressure may force the fluid into 
the Eustachian tube. This accident is fortunately rare. The writer 
has the record of only one such instance, in which a physician using 
the douche for the first time, suddenly felt the water rush into one ear ; 
the hearing was instantly lost and never recovered. The accident 
occurred some years ago, and the exact condition was not ascertained 
at the time. 

After recovery from coryza, tonics, and especially iron, should be 
employed to fortify the system against a repetition of the attack. 

Important prophylactic measures consist in exercise in the fresh air, 
cheerfulness, attention to the state of the skin, the use of woollen 
underwear, and the avoidance of dissipation, late hours, reading with 
the head near a hot lamp, dust, draughts, or anything which lowers 
the vital forces. 

CROUP. 

(See Diphtheria.) 



CROUP, SPASMODIC. 

As this is a spasm of the glottis depending for its causation upon 
catarrh of the mucous membrane of the larynx, and as it is due most 
commonly to some reflex irritation, such as dentition, indigestible 
food, or sudden atmospheric changes, the treatment is both prophy- 
lactic aud curative. Prophylaxis consists in the avoidance of cold, 
the use of a simple diet, particularly at the evening meal, the render- 
ing of the air of the bedroom moist by means of steam, or at least by 
the avoidance of dust-laden, furnace-heated air, and by the removal of 
dental irritation and nasal hypertrophies, which make the child a 
" mouth-breather." Small doses of the bromides, chloral, belladonna, 
or opium may be resorted to at bedtime. A very useful prescription 
for this purpose is the one that follows : 

R> — Sodii bromidi 3j. 

Syrupi lactucarii . . . . . . f^ij. M. 

S. — Teaspoonful to a dessertspoonful on going to bed, and once or twice during 
the night. 

When the attack is present, a cold cloth should be wrapped about 
the neck and the child placed at once in a hot bath, the air of the room 
being moistened by the steam escaping from a kettle of boiling water 
or by pouring water upon unslaked lime. If the paroxysm is very 
severe a few whiffs of amyl nitrite may be employed, or antimonial 
wine in the dose of 1 drachm may be used to cause vomiting. It is 
also useful to disseminate the fumes of menthol through the air of 
the room by heating some crystals in an iron spoon. If the fumes 
are strong enough to produce a distinct odor they are present in suffi- 
cient amount. 



438 DISEASES. 

The drugs first named do good by decreasing reflex excitability, 
while the emetics indirectly relax the spasm by the nausea and 
depression which they produce. 



CYSTITIS, ACUTE. 

If, by reason of exposure to cold, injury, the introduction of foreign 
bodies, such as dirty catheters, or the presence of gonorrhoea or other 
disease due to a septic poison, an acute inflammation of the bladder 
ensues, it is accompanied by a sensation of weight and vesical fulness, 
by pain, tenesmus, and inability to retain the urine. Sometimes the 
last-named condition may be reversed, and retention of the urine be 
present. 

If the general system responds to the local inflammation, as evi- 
denced by increased arterial excitement and fever, aconite, in full 
doses of the tincture, should be used, and it should be combined with 
small amounts of sweet spirit of nitre and citrate of potassium, as 
follows : 

R . — Tinct. aconiti f ^j. 

Spirit, sether. nitrosi f ,^j. 

[Liquor, potassii citratis . . q. s. ad f|?j. M. 
S. — Dessertspoonful every four hours until all fever ceases and the pulse is quiet. 

At the same time a hot compress should be applied over the blad- 
der, but it should not contain turpentine or any irritant substance 
which may be absorbed from the skin and when eliminated by the 
kidneys irritate the bladder walls. Leeches may be placed upon the 
perineum or cups« applied to the region of the sacrum. In some cases 
belladonna may be used with or without aconite in the dose of 5 to 
10 drops of the tincture three times a day, and it is worthy of note 
that this drug is particularly serviceable in the cystitis due to cold ; 5 
drops of liquor potassa every four hours may be substituted for the 
citrate of potassium, or the acetate of potassium may be used. If 
there is much pain and bearing-down, an enema of 30 drops of laud- 
anum in 2 ounces of starch-water may be employed, or the opium 
may be given in suppository. 

Sometimes a belladonna suppository is of more service, and an 
iodoform suppository will often relieve the pain by its local anaes- 
thetic effects. Hot enemata, without any drugs, are often valuable 
as a means of relief, and a hot sitz-bath is very efficacious. Can- 
nabis indica, if an active preparation can be had, is better than opium 
to relieve the pain, since it seems to affect the bladder favorably. 
The other curative measures are hygienic, and consist in the mainte- 
nance of the recumbent posture, absolute physical and mental rest, 
the avoidance of all foods which are stimulating, as rare meats and 
highly-seasoned dishes, and abstinence from all varieties of alcoholic 
beverages. 

Should the inflammation be severe enough to become purulent the 
physician should order salol in the dose of 10 grains three times a 



CHRONIC. 439 

day. This drug being broken up iu the bowel into carbolic acid and 
salicylic acid is so eliminated and renders the urine antiseptic. 

Laxatives are to be employed with persistence if the bowels are 
confined, and salines in the early stages are generally better than 
vegetable purges 

Quinine should not be used against the fever, as it is contra-indicated 
owing to its irritant effects upon the bladder. 



CYSTITIS, CHRONIC. 

The treatment of chronic cystitis is entirely different from that of 
the acute form, and consists in the use of remedies which will stimu- 
late the diseased mucous membrane, cause a normal secretion of mucus, 
and so influence the urine that the mucus already formed will be 
passed out and the fluid rendered alkaline or acid, as may be desired. 
When the secretion of mucus in large amount is persistent, the urine 
should be rendered alkaline by the use of liquor potassa, or the 
citrate, acetate, or bicarbonate of potassium. The bitartrate of potas- 
sium is eliminated as the bitartrate of potassium, and, as it is acid, 
cannot be employed. 

We acidify the urine because of the necessity of dissolving the 
phosphates and preventing deposits in the bladder and elsewhere. 
The two best drugs for this purpose are boric acid, in the dose of 5 to 
10 grains, or benzoic acid, in the same amount. Both of these may 
be given in pill form, made by adding a little glycerin. The rule 
may be laid down that, if the urine is high-colored and is strongly 
acid, alkalies are useful ; whereas if it is light in color, but loaded 
with phosphates, the acids named should be employed. Salol may be 
given to prevent decomposition of the urine. 

One of the best measures for the relief of chronic cystitis is to wash 
out the bladder daily, by irrigation with warm water, or water con- 
taining bichloride of mercury in the proportion of 1 to 10,000, as 
this washes away all mucus and uric acid deposits, and prevents irri- 
tation. Solutions of nitrate of silver have been used with great suc- 
cess where the discharge is muco-purulent, and Thompson recommends 
the use of a solution of the strength of 1 grain to 4 ounces of water, 
gradually increased to 2 grains to the ounce. Others, such as Gard- 
ner, Richardson, and Potter, recommend the use of stronger solutions, 
5 grains to the ounce of water, claiming that while these amounts may 
produce serious effects in some instances, they are very efficacious in 
obstinate cases. The physician should have at hand a solution of 
common salt, which he should inject into the bladder at once if the 
action of the silver solution is too painful, or seems excessive. This 
treatment is only suited to the most chronic cases. 

The remaining remedies which are employed internally in chronic 
cystitis are those which are directed to the improvement of the mucous 
membrane of the bladder, and consist in buchu in the form of the 
fluid extract in the dose of J to 1 drachm, well diluted, arbutin or 



440 DISEASES. 

ursin, 3 to 5 grains, or the fluid extract of uva ursi, dose 30 drops to 
1 drachm. All of these are better fitted for the treatment of subacute 
than chronic cystitis, as they are not sufficiently active for the chronic 
forms. 

In cystitis of an advanced type, with great vesical atony, strych- 
nine is of service, and drop doses of tincture of cantharides do great 
good. Turpentine may also be used with advantage in 5 to 20-drop 
doses, as may also the oils of eucalyptus, sandalwood, cubebs, and 
copaiba. 

All these measures are suitable for the treatment of cystitis in the 
male and female, but it is to be noted that injections into the female 
bladder are made much more readily than into that of the male, be- 
cause of the shortness of the female urethra. In either case the 
operation is best performed by attaching a small funnel to a soft 
rubber catheter and filling the bladder by raising the funnel above 
the patient's belly. Creolin has been highly recommended by Parvin 
in the strength of from 1 to 2 per cent, with water. The irrigation 
is to be performed every twenty-four hours. 



DIABETES INSIPIDUS. 

In diabetes insipidus the disorder exists simply as a profuse urin- 
ary flow dependent upon some disorder of the innervation of the 
kidney, or upon atony or relaxation of this organ. The treatment 
consists in the use of astringents and tonics, and in some cases in the 
employment of opium or belladonna, particularly if the over-secretion 
rests upon nervous irritability. Gallic acid may be used in 20-grain 
powders three times a day, and the fluid extract or wine of ergot is 
often of service given in the dose of 30 drops to a drachm of the 
former or a wineglassful of the latter. As tonics, the sulphate of 
iron and strychnine are indicated. 



DIABETES MELLITUS. 

In the treatment of this affection it should be remembered that it is 
the result of disordered function and is not a disease in itself, but a 
symptom of several disease processes. For this reason a remedy which 
succeeds in one case may fail in another. 

The treatment of diabetes mellitus is dietetic and medicinal. The 
diet list should consist largely of meat, particularly of meat with 
some fat attached to it, as the fat takes the place of starch in the 
nutrition of the body. The avoidance of starches of all kinds, and 
the use of dry wines, or those containing little or no sugar, is to be 
insisted upon. Beers and malt liquors must be forbidden. Accord- 
ing to some authorities, the patient should be placed in bed and put on 
a purely milk diet, generally of skimmed milk, although buttermilk is 
better than any other form, owing to its lactic acid and lack of sugar. 



DIABETES MELLITUS. 441 

Koumyss for the same reason is very valuable. The chief aim of the 
patient must be to avoid all substances which can be readily converted 
into sugar by the organism. 

The following list of foods aud drinks maybe taken, and the second 
list forbidden. 1 

Meats of all kinds (except liver), eggs, fish, cheese, butter and cream. 
Oyster-plant, asparagus (?), tomatoes, almonds, pecan nuts, butternuts, 
walnuts, and cocoanuts. String-beans, beet tops, radishes, mushrooms, 
lettuce and water-cress, cauliflower, spinach and onions. Celery and 
cucumbers may also be permitted. 

Of the foods and drinks to be avoided we have all forms of sugar,, 
all forms of starch, such as ordinary flour, cornmeal, arrowroot, sago, 
tapioca, oat-meal, barley, carrots, beets, parsnips, pie-plant, peas and 
beans, chestnuts and most of the fresh fruits, cider, beers, champagne, 
sweet wines and honey. 

The treatment of diabetes by drugs is varied by the condition of 
the patient, the cause of his disease, and the quantity of sugar in the 
urine. While the drugs most commonly employed are used in many 
instances without any knowledge of how they act, and have each of 
them a set of warm supporters among prominent authorities, much of 
the treatment must depend upon whether or not a rheumatic or gouty 
taint is the cause of the trouble, or whether it is due to high living, 
little exercise, and a plethoric, congested, overloaded system. In the 
first class of cases iodide of potassium and the salicylates will be most 
serviceable ; in the second class, a restricted diet, moderate exercise, 
and purgation to relieve engorgement of the hepatic artery and veins 
may be needed. In the cases of gouty diabetes where relief does not 
follow the use of the iodides and colchicum, resort must be had to 
arsenic and lithium citrate or carbonate, a combination peculiarly 
adapted to such a condition according to several authorities. Indeed, 
arsenic is a sheet-anchor with many practitioners in all forms of 
diabetes, and should be given in fairly large, constantly repeated doses 
for a long time. A very much larger body of medical men rely on 
opium, or one of its alkalies, codeine. The former is used in the 
dose of J to J grain three times a day ; the latter 1 to 5 grains three 
times a day, and I have found it very useful. The chloride of gold 
and sodium (y 1 -^ grain) has been highly recommended by Bartholow, 
and ergot by Wood and DaCosta. In cases depending upon rheuma- 
tism, the use of salicylic acid is often of great value, the dose being 
10 to 15 grains three times a day. 

In cases of diabetes in which diet will control the disease, the best 
clinicians insist that drugs should be avoided, for when opium or any 
of its alkaloids are used it is necessary to give rapidly increasing doses 
w r hich finally become enormous, as much as 7 grains of morphine a 
day being taken by some persons. Once having begun the use of 

1 It is worthy of note that certain persons may have a slight glycosuria without 
serious injury, who waste under a limited diet, requiring ordinary fare to support 
the body plus the diabetic drain. 



442 DISEASES. 

drugs in severe cases it is very dangerous to stop thern, for clinical 
experience has shown that many of these patients waste rapidly and 
generally break down when this is done. In regard to the time of 
day at which to give the morphine or codeine, it is generally consid- 
ered best about one hour after meals. Under the circumstances the 
drugs seem to decrease diuresis more than if the dose precedes the 
meal ; further than this, the stomach is not disordered. In some 
cases results will be obtained from opium when its individual alkaloids 
fail. Careful observation of the patient should be carried out to de- 
termine the proper beginning and subsequent doses, and if at first the 
opiates fail to give relief discouragement should not be felt. 

Jambul is a remedy which has been widely used by clinicians for 
the relief of diabetes with such varying results that its position in 
therapeutics is uncertain. This is probably because it is effective in 
one form of diabetes and not in another, and we are unable to make 
the clinical distinction. Jambul is used in powder or the powder is 
placed in capsules or pills. The dose is 5 to 30 grains once to thrice 
daily aud gradually increased. As much as an ounce has been given 
in twenty-four hours. This medicament is said to be advantageously 
combined with a pure meat diet in diabetic cases. 

The excessive thirst of diabetes can be best allayed by the use 
of acidulated water or alkaline waters containing non-purgative salts. 
It is useless to cut off the water-supply, to the production of great 
suffering, but the patient should use moderation in drinking so far as 
possible. 

The wasting coming on in diabetes is to be treated by careful diet, 
rest, and the supply of all the food which the patieut can digest. In 
many instances, the amount of aliment ingested is extraordinarily large, 
while in others digestion is so impaired that food cannot be taken. 

If cachexia comes on, iron, strychnine, bitter tonics, the lacto-phos- 
phates of lime and sodium, and astringents, are to be used to support 
the circulatory and nervous systems. Tea and coffee and all forms 
of food needing sweetening, may be rendered palatable by the use of 
saccharin or of glycerin. The former passes through the body un- 
changed, the latter increases the glycogen in the liver but checks the 
formation of sugar (Ransom). 

Unfortunately we have no positive knowledge as to the minute and 
innermost causes of diabetes, nor the manner in which the glycosuria 
is brought about, and in consequence cannot explain the manner in 
which opium, codeine, or other drugs produce relief. 



DIARRHCEA AND DYSENTERY. 1 

Diarrhoea is a term loosely applied, with perfect correctness, to all 
forms of intestinal disturbance accompanied by the passage of liquid 

1 The articles on Cholera, Cholera Morbus, and Cholera Infantum should be care- 
fully read in connection with this article. 



DIARRHCEA AND DYSENTERY. 443 

stools, and its meaning, a to run through/' expresses the state it repre- 
sents. 

The treatment of each form of diarrhoea depends upon its cause, 
and no case can be intelligently treated in which the physician fails to 
recognize this aspect of the case. Diarrhoea is but a symptom, not a 
disease, and must be regarded solely as an evidence of intestinal dis- 
order. 

While the same drugs are prescribed in many forms of the trouble, 
we may divide cases of diarrhoea into four classes as follows : (a) Those 
in which the laxity is due to a catarrh, acute or chronic, of the intes- 
tinal mucous membranes, causing the passages to contain mucus. 
(6) Those where, owing to disordered innervation, a profuse outpour- 
ing of liquid takes place from the bloodvessels into the intestinal 
lumen, (c) Those in which, owing to disease, the glands fail to pre- 
pare juices to digest the food properly ; and finally (d) those cases 
where ulceration causes irritation and bloody purging. 

The treatment of the catarrhal form first named consists primarily 
in the regulation of the diet, which should be made up chiefly of milk, 
boiled or predigested, or of milk whey, and in the administration of 
castor oil or other mild purge, such as sulphate of magnesium, to 
sweep out fermenting food and mucus. Enough laudanum should 
accompany this oil to prevent griping, and it is well to add bicarbonate 
of sodium, grains 20 to 30, to the dose, both to aid the action of the 
oil and to render the bowel alkaline in reaction (normal) instead of 
acid, as caused by the fermentation abnormally present. A mustard 
plaster or other counter-irritant should be applied to the abdomen. 
Often in the milder forms of mucous diarrhoea this is all that is needed, 
but more frequently it must be followed by the use of tonics and 
astringents, such as nitrate of silver and hyoscyamus in the following 
pill : 

R. — Argenti nitratis . . . . . . gr. ij. 

Extract hyoscyami gr. v. M. 

Ft. in pil. no. x. S. — One 3 times a day. 

° r > 

^. — Plumbi acetatis . . . . . . gr. ij. 

Extract, opii gr. ij. M. 

Ft. in pil. no. x. S. — One three times a day. 

If these stop the diarrhoea aud there still seems to be a tendency for 
it to return, or atony is present, we should use a pill containing the 
extract of chiretta, or employ nitro-muriatic acid, or, better still, nitric 
acid and cardamoms, because the constant tendency to relapse indi- 
cates a deficient secretive action on the part of the intestinal glands, 
which these remedies are prone to improve : 

fy.. — Acid, nitric, dil fgj. 

Tr. cardamomi comp. . . . . . fjij. 

Tr. gentian, comp f 3 ij. M. 

S. — Dessertspoonful every four hours. 

If the catarrhal state is persistent, no remedy compares to the chlo- 
ride of ammonium, dose 5 grains every four hours in liquorice and 



444 DISEASES. 

water. Where the catarrhal state is exceedingly chronic and obstinate 
it is well to employ 3 to 5-grain doses of potassium iodide. 

If the pills already named do not control the diarrhoea, the follow- 
ing may be used : 

R. — Acid, sulph aromat . f^jss. 

Spt. chloroformi f .5 ij . 

TV. opii camphorat f jf ij . 

Syr. zingiberis . . . q. s. ad f,^iv. M. 

S. — Dessertspoonful every two hours. 

Or, 

R.— Tr. kino 

Tr. catechu comp. 

Misturse cretse 

Aquse cinnamomi . . . q. s. ad f §vj. M. 

S — Shake well before using. Tablespoonful every three hours. 

In the second form of diarrhoea named — that in which serous or 
watery purging is present — the treatment is radically different. In 
these cases the bloodvessels of the gut are relaxed and leaking, and 
must be contracted and made water-tight. This dilatation may result 
from fear (" nervous diarrhoea "), from exposure to cold, or from ex- 
haustion, extreme heat, and irritant food. If from irritant foods, they 
are generally swept out in the first flush of liquid. 

The measures to be adopted consist in those directed to the contrac- 
tion of the dilated and relaxed bloodvessels, and the restoration of the 
proper nerve-supply to the parts. 

As the splanchnic nerves are the vasomotor nerves of the intestine 
as well as the inhibitory nerves of peristalsis, it is evident that we 
must use drugs which will cause stimulation of these fibres, and the 
chief of these is found to be opium, which diminishes intestinal peri- 
stalsis and secretion by just such an influence. In the same way 
small doses of volatile oils are of service, and camphor and spirit of 
chloroform may be used. As there is relaxation, astringents are indi- 
cated ; and as sulphuric acid is not only astringent, but eliminated by 
the lower bowel, it is peculiarly serviceable. We find, therefore, that 
the following prescription fulfils every indication : 



M. 



ty. — Acid, sulph. aromat. . 


. . . fgss. 


Olei cajuputi 


. gtt. xl 


Ext. hsematoxyli fl. 


. . . f#j. 


Spt. chloroformi . 


• • • f*j. 


Syr. zingiberis 


. q. s. ad fgiij. 



S. — Teaspoonful in water every two or three hours. 



If desired, kino or catechu may be used in lieu of the hsematoxylon, 
or the oil of cloves substituted for that of cajuput. Camphor or pare- 
goric may also supplant these drugs. 

In some instances these attacks appear to depend upon hepatic dis- 
order, and the only cure, aside from partial relief, is to be obtained by 
the use of 2 to 6 grains of mercury with chalk (hydrargyrum cum 
creta) or calomel given in -g- to J grain doses. What is said of intes- 
tinal disorder from lack of secretion under the heading of Cholera 



DIARRHCEA AND DYSENTERY. 445 

Infantum applies very forcibly to these cases, and diarrhoea may per- 
sist for weeks, or only temporarily be held in check by the most pow- 
erful drugs, until the physician thoroughly flushes the intestine with 
bile by the use of prodophyllin and calomel. 

Wood has highly recommended the use of a bismuth powder con- 
taining a drop or two of carbolic acid. 

The third class of cases seems, in many instances, to lie between 
those just spoken of and those in which the writer has placed them; 
they occur chiefly in children and consist in the foetid, " mousy "- 
smelling stools of summer diarrhoea, with green, spinach-like masses 
of semi-digested food, or distinct lientery. They may be due to defi- 
cient glandular action in any part of the alimentary canal, and are 
often cured by the use of pepsin and hydrochloric acid to perfect the 
gastric processes. In other instances the duodenum is at fault, and 
should be excited by small doses of nitro-muriatic acid, or by podo- 
phyllin in the dose of -fa to fa of a grain, with a little milk-sugar, or 
given in alcoholic solution. Similarly, ipecac in powdered form may 
be used in the dose of J to J a grain three times a day. In the case 
of children, who are often sufferers from rickets, phosphate of sodium, 
lime salts, and common salt should be freely given. 

For the purpose of establishing intestinal antisepsis, carbolic acid 
may be used, and naphthalin, thymol, and other drugs of this class 
have been employed, particularly salicylic acid. None of them com- 
pare with carbolic acid, however, which should be used in 1-drop doses 
on bismuth or in water. When the carbolic acid is given to a child 
it is best prescribed in such a way that in each teaspoonful a half-drop 
is present. This teaspoonful of liquid should be placed in a table- 
spoonful of water. 

Sometimes a good-sized, brisk purgative dose of calomel followed 
by a saline does good in these cases, if they are strong enough to 
permit of its use. 

The regulation of the diet, which should consist in sterilized milk 
or koumyss, the former being predigested, is of the greatest impor- 
tance, and the proportions of the milk, water, and cream placed in the 
bottle for the baby should be varied until a mixture is formed which 
is exactly fitted to the digestion of the case. The after-treatment 
consists in the use of tonics and a carefully regulated diet, which 
should be largely composed of milk and milk foods. 

The fourth type, generally known as dysentery, is due in some 
cases to hepatic trouble, in others to the drinking of impure water, 
and in the third place to exposure to heat and bad food. It is in 
most cases a very obstinate form of diarrhoea, requiring much skill 
and patience for its cure. In the chronic forms deep ulcers may 
exist ; in the milder cases a high inflammation is present. 

In those cases which are due to exposure to heat and hepatic 
trouble there are two remedies which are far above all others in value 
and should always be resorted to. The first of these is ipecac, the 
second is calomel. 

The ipecac should be used in a special manner to be effective (see 



446 DISEASES. 

Ipecac), and the calomel should be used iu full purgative amounts, 
but is contra-indicated if much weakness is present. 

If the passages are slimy and bloody T ^- of a grain of bichloride of 
mercury every hour or two is of service, and if much blood is present 
injections of the distilled extract of hamamelis are of value. In some 
forms of dysentery due to acute inflammation large enemata of iced 
water are of the greatest value. The water should be ice-cold and at 
least a quart injected by hydrostatic pressure. This method can only 
be used in strong persons. The following mixture may be injected 
into the bowel in place of cold water in feeble cases : 

R. — Sodii boratis gj. 

Tinct. benzoin. a f^j. 

Spt. camphorse f ^j. 

Aquae bullientis . . . . . . Oij. M. 

If the ulcers are very old and chronic, nitrate of silver injections of 
the strength of 10 to 20 grains to the pint of water may be employed 
in large bulk, a salt solution being at hand for the destruction of the 
silver salt if the action which ensues is too severe. 

For the manner in which to use these intestinal irrigations see 
Cholera and Cholera Infantum. 

Recently the injection of water or medicaments into the bowel for 
the purpose of influencing the intestinal wall has given way in the 
hands of prominent physicians to irrigation by means of an inlet and 
outlet tube. The inlet tube should be attached to a fountain syringe, 
and the outlet tube be long enough to reach to a vessel by the side of 
the bed and of sufficient calibre to carry off flaky mucus. In many 
cases of dysentery of a mild form rectal irrigation will suffice, but if 
the entire colon is involved larger injections are necessary. The 
irrigation should be continued until the returning fluid becomes 
perfectly clean and free from foreign particles. If the bowel move- 
ments are very frequent, the injections may be made every three 
hours. Probably the best solution to employ for irrigation, where 
much mucus and pus is present, is one composed of bichloride of 
mercury 1 : 5000. When this is used, a pure water injection or one 
of 1 : 30,000 should follow it in order to prevent absorption of the 
mercury into the system. If for any reason the effect of the bichloride 
is feared, boric acid may be used in the proportiou of 1 drachm to the 
pint. 

Tannic acid is an intestinal antiseptic, and can be employed in the 
strength of 1 drachm to the pint for irrigation purposes. 



DIPHTHERIA AND MEMBRANOUS CROUP. 

Diphtheria is at first a distinctly local disease, the membrane in the 
throat forming a nidus from which the entire body ultimately becomes 
filled by the poison manufactured by the microorganism peculiar to 
the malady. The author does not believe that membranous croup 



DIPHTHEKIA AND MEMBRANOUS CROUP. 447 

and diphtheria are distinct diseases, but regards one as the mild or 
undeveloped form of the other. As the treatment is identical, be the 
belief of the physician what it may, the case should always be consid- 
ered as true diphtheria until it is proved to be some other disease. 

The treatment of the throat-changes before the membrane appears 
should consist in the use of sufficiently large doses of belladonna to 
impress the system, accompanied by painting the pharyngeal wall 
with a solution of chlorate of potassium of the strength of 15 grains 
to the ounce, or, if this seems too strong, only 5 grains to the ounce 
may be employed. After the membrane is formed, its dissolution may 
be carried on by the use of the atomizer spray with lime-water, or 
with lactic acid solution of the strength of 30 grains to the ounce, 
every hour. In other instances a solution of trypsin, one of the fer- 
ments of the pancreatic juice, may be used on a swab or by means of 
a spray to digest the membrane. Other eases do well when a solution 
of boric acid is applied dissolved in glycerin in a w T ater-bath in the 
strength of 1 to 30. Still another solution, which may be used by 
means of a spray from an atomizer with great advantage, is made as 
follows : 

H . — Sodii bicarbonatis V - - 

Sodii boratis J ' ' * " 

Aquae f^ ij. M. 

S. — Use in atomizer. 

After the use of this solution there is often an expectoration of 
creamy mucus mixed with particles of false membrane. 

Of all the treatments which are directed against the membrane, 
laden as it is with the microorganisms of the disease, none compare, 
in the opinion of the author, to the peroxide of hydrogen. A cotton 
swab should be soaked with the strong undiluted 15-volume prepara- 
tion and pressed against the mucous membrane which is diseased. 
The effect is often extraordinary. After a few applications the false 
membrane appears to exist only in disorganized shreds. If the nasal 
chambers become affected, a solution of the strength of from 1 to 
4 to 2 to 4 parts of peroxide of hydrogen (15-yolume) should be used 
in a spray or w T ith a syringe, the child breathing through its mouth. 
The applications should be made as rapidly as the membrane forms. 
Another very useful application, which is more readily obtained than 
the peroxide of hydrogen, is tincture of the chloride of iron undiluted. 
A cotton applicator is used as with the peroxide of hydrogen, but care 
must be taken that the cotton is not so fully soaked in the iron solu- 
tion as to permit of drops falling into the larynx or on the teeth. 

Cohen states that in diphtheria the disengaging of sulphurous acid 
fumes by the method usually carried out in the disinfection of rooms 
is a useful prophylactic measure against the contraction of the disease. 

By far the best thing for the physician to do to prevent or limit the 
formation of membrane, consists in the judicious use of mercury. This 
is to be done by employing -^ to J grain of corrosive sublimate in 
divided doses in twenty-four hours, or in other words, by the adminis- 



448 DISEASES. 

tration of ^ grain every hour, or by using calomel ^ to \ grain every 
hour,. until the evidences of the action of the mercury are shown by the 
loose stools. It is said the stools following this use of corrosive sub- 
limate in diphtheria sometimes resemble " frog spawn " — that is, are 
frothy-looking. The object in using the mercury is to cause a lack of 
plasticity in the blood, so decreasing the exudation of fibrin. Having 
made this attempt, which is only to be tried in sthenic cases, sup- 
portive measures are to be resorted to, and for this purpose tonics and 
stimulants with nourishing food are to be employed. Tincture of the 
chloride of iron, quinine, and strychnine are of service to keep the 
kidneys active, to stimulate the heart and respiration, and to support 
the vital forces. 

The tincture of iron is given internally by some physicians from the 
beginning to the end of the attack, but it certainly does the most good 
after the disease is thoroughly under way, and should be used in large 
quantity if great exhaustion and anaemia appear. The dose may be 
as much as 2 drops every hour to a child of four years, or even more 
than this may be given. 

The food of a child during an attack of diphtheria should consist in 
pancreatized and sterilized milk. The object is to keep the bacillus 
limited to the throat, yet with every drink of ordinary milk they are 
taken into the stomach in a culture medium. It is always best to use 
an antiseptic spray or swab before giving the sterilized milk, to render 
the mouth as far as possible antiseptic, and to avoid the gagging, which 
may result in vomiting, if the swab is used after taking food. 

Another treatment which is often of great value in the treatment of 
diphtheria is the use of turpentine, either by inhalation or by the 
stomach. Its use should follow the employment of the mercury should 
this drug fail to abort the formation of the exudate. All those who 
have given turpentine internally in diphtheria agree that the dose 
should be very much above that recommended in other states. Thus 
it is stated that from J to 1 drachm should be given three times a day. 
The following prescription may be employed : 

E. — Spt. terebinthinse fifij- 

iEtheris fortior f J j. 

Alcohol. q. s. ad f^iv. M. 

S. — Teaspoonful three times a day in cold water. 

If the patient is old enough the turpentine may be given in cap- 
sules, and followed at once by a drink of milk or water to prevent 
irritation of the stomach by the concentrated stimulant. 

Turpentine acts in these cases as a respiratory, cardiac and general 
systemic stimulant and at the same time as an antiseptic in the mouth, 
alimentary canal and kidneys. It also acts as a diuretic and prevents 
renal torpidity. 

The other method of using turpentine is by inhalation, and is 
highly recommended by J. Lewis Smith. The following prescription 
is placed in water in the proportion of 2 tablespoonfuls to a quart, 
and this mixture is then placed on a gas or oil stove in a broad open 



DKOPSY. 449 

vessel aud allowed to boil constantly. The air of the sick-room is 
soon laden with the vapor, which is not offensive. The prescription 
is as follows : 

I£. — Acid, carbolici \ aa f 5i 

Olei eucalypti J °J- 

Spt. terebinthinae f^viij. M. 

S. — Use as directed. Label : Poison if taken internally. 

Hundreds of other measures have been recommended and em- 
ployed until almost every physician has his favorite method, but the 
treatments here given will be found advantageous in the majority 
of cases. Where the glands of the neck threaten to suppurate, ice- 
bags should be applied to the throat and pieces of ice held constantly 
in the mouth while the tincture of iron is pushed in as full amounts 
as possible. 

If suffocation is imminent, inhalations of oxygen are to be used and 
atropine or strychnine employed, although tracheotomy or intubation 
may be necessary. 

Chlorate of potassium must never be given internally, as the kid- 
neys are already severely inflamed, and this drug is not only useless 
when so given, but is in addition a renal irritant. 

Although the author has been criticised for this last statement, he 
is convinced of its truth ; aud that he is not in error is proved by the 
fact that no less eminent authorities than H. C. Wood and J. Lewis 
Smith agree with him. 



v » 



DROPSY. 

Dropsy is to be regarded as a symptom, not as a disease in itself, 
which may arise from many causes, such as cardiac, pulmonary, or 
renal diseases, or depend upon obstruction, from various causes, to the 
normal flow of the blood and lymph through the vessels and tissues. Its 
existence is dependent upon so many causes of a still more indirect nature 
that it is almost impossible to notice all of them, but the following 
consideration of the subject will at least make clear some of the reasons 
for its occurrence and indicate the means which are to be taken for its 
relief. 

At the very start we are confronted by facts which seem para- 
doxical, but which are in reality quite reconcilable. These are, that 
low arterial pressure predisposes to dropsy and that high venous 
pressure does likewise, or, in other words, that the cause of exudation 
on one side of the circulation is its prevention on the other. 

The explanation of these statements lies in a thorough understand- 
ing of the physics of the circulatory system and its anatomical struc- 
ture. It will be remembered that dropsical exudation takes place 
from the capillaries, and that the integrity of the walls of the blood- 
vessels and lymphatics depends upon normal nutrition, or, in other 
words, upon a proper blood-supply. As a consequence, dropsy may 
be due to poorly nourished vessels as much as to any other cause. 

29 



450 DISEASES. 

Further than this, a watery state of the blood permits abnormal 
exudation. 

The force exercised upon the column of blood as it is driven out 
by the heart iuto the aorta may be considered as the chief support of 
the capillary circulation, so that if the heart be weak the pressure 
falls in the arteries, and in consequence the rapidity of flow is de- 
creased in the capillaries, while, on the other hand, an increased 
cardiac activity hastens the capillary circulation. As the arterial 
pressure and force depend not only upon the heart force, but also upon 
the tonicity of the arteries which carry the blood stream, it becomes 
evident that dilated arteries must lower blood-pressure even if the 
heart be strong, although practically the heart and vasomotor system 
generally fail or increase in tone together. We find, therefore, that 
a weak heart or a relaxed artery both tend to cause stagnation of the 
blood in the capillaries, and having found that such stagnation is 
productive of exudation it is not hard to discover why low arterial 
pressure is a cause of dropsy. 

Having shown this to be true, let us turn to an explanation of the fact 
that a high pressure in the veins is productive of the same changes. 

Here the normal pressure is almost nothing, being much less than 
in the arteries, and considerably less than in the capillaries. The 
result of this is, that in health the blood flows rapidly from the high 
pressure of the artery to the low pressure of the vein, and passes 
through the small veins under a gradually decreasing pressure until 
it reaches the heart. Any obstruction to this venous flow must in- 
crease the venous pressure, and the venous pressure being increased 
the rapidity of flow through the capillaries must be decreased. The 
whole subject may be made more clear by the following example : 

Supposing that two iron tubes are connected at one end by several 
lines of rubber tubes (the capillaries), and that water is flowing into 
the first tube, or the artery, under a pressure which is represented by 
the figure 100, while the resistance to the flow in the second tube, 
the vein, is represented by the figure 0. It at once becomes evident 
that the rapidity of the flow through the connecting rubber tubes 
will be very great, whereas, if the pressure in the first or arterial 
tube is decreased to 50 the rapidity is decreased to one-half, or if the 
pressure in the second tube be increased to 50 instead of remaining 
at the same changes will occur ; in either instance capillary flow is 
lessened, and exudation is caused. This is the pathology of dropsy, 
and having understood it, let us proceed to discover the causes of 
dropsy in various diseases. 

In cardiac disease it is due to a weak heart being unable to supply 
the arteries with enough blood to maintain the normal pressure, or to 
a damming-up of blood in the venous system as the result of the 
imperfect emptying of the cardiac cavities. In the first instance low 
arterial pressure produces dropsy ; in the second, high venous pressure 
has a similar effect. 1 

1 For an explanation of the changes in the action of the muscle, valves, and cardiac 
action in heart disease, see Heart Disease. 



DROPSY. 451 

In renal troubles the dropsy depends more upon the lack of proper 
nutritive processes in the capillary walls and upon changes in the 
blood-pressure than upon other causes. If the kidney is diseased it 
may not be able to eliminate the proper quantity of liquids, which 
accumulate and finally escape into the tissues, while the same failure 
in renal function causes disease of the blood-paths themselves, and 
often produces cardiac complications. 

Hepatic troubles cause dropsy by producing pressure upon the large 
bloodvessels going to the liver, and, in consequence, the exudation is 
generally confined to the lower limbs and abdomen. If the hepatic 
trouble be severe, some failure in the nutrition of the bloodvessels and 
changes in the quality of the blood may ensue. 

Pulmonary disease rarely causes dropsy unless the venous pressure 
is greatly increased and productive of cardiac dilatation, or, as in 
phthisis, where the changes in the nutrition of the body involve the 
bloodvessel walls and the blood. 

Having spoken of these causes of dropsy, it remains for us to con- 
sider its treatment, which may be divided into two parts, namely, that 
directed to its removal when ouce the liquid is poured out, and its relief 
or cure by direct attention to its causes. The means for the removal of 
the fluid are suitable in all cases, be the cause what it may, unless the 
dropsy be of renal origin. Whenever an accumulation of liquid takes 
place in the tissues, drugs or measures must be resorted to which will 
cause the emunctories of the body to get rid of it. In ascites, in 
particular, we may employ elaterium in the dose of -|- of a grain, or 
elaterin in the dose of ^ of a grain, placed in the mouth and 
washed down by a little water, or, if this is not used, the compound 
jalap powder may be resorted to, in the dose of 20 to 30 grains, 
and to it may be added, to increase its efficiency, 10 grains more of 
bitartrate of potassium than the official powder contains. These two 
remedies are particularly serviceable in reual dropsies, since the ela- 
terium is supposed to aid in the elimination of urea by the bowel, 
while the cream of tartar in the jalap powder increases the action of 
the kidneys. 

The cream of tartar is not to be used in cases of acute nephritis. 

Compound extract of colocynth may be employed in the dose of 
2 to 6 grains, according to the state and idiosyncrasy of the patient. 

All these remedies relieve dropsy by causing so great an outpouring 
of liquid from the bloodvessels of the body that the liquids in the 
tissues are taken up by the depleted bloodvessels to replace the loss 
through the action of the purgative. 

In other words, these purgatives render the alkalinity of the blood 
greater by concentration, and absorption of fluid occurs by reason of 
the following physiological and physical facts : 

As is well known to every physiologist, the passage through a 
bloodvessel of a salt solution of less than -^ of one per cent, causes 
an abstraction of salts from the surrounding tissues by the circulating 
fluid, in order that the amount of salts in the vessels and tissues may 
be identical. At the same time the tissues become infiltrated with 



452 DISEASES. 

liquid. On the other hand, if the solution be stronger than the 
normal, the liquid leaves the tissues to euter the vessels, and the 
tissues in consequence shrink. 

When salines are given to relieve dropsy they must be administered 
in concentrated or saturated solution and on an empty stomach, total 
abstinence from the drinking of water being insisted upon until they 
have fully acted, for the reasons given in the last paragraph. For 
this reason they should be given an hour or so before breakfast. If 
these directions are not followed this treatment is useless. 

The other means which we possess for the removal of dropsy are 
by way of the kidneys and skin. If the kidneys are hopelessly dis- 
eased that pathway is almost useless, but if they are only passive, or 
partly inactive, diuretics may be used to stimulate their secreting 
structure and to increase the leakage of liquid through them by 
increasing blood-pressure. Such patients should be placed almost 
entirely on a milk diet, and many of them will greatly improve under 
the use of buttermilk to the exclusion of other nourishment. If this 
cannot be taken, sugar of milk may be employed as an active diuretic. 
(See Sugar of Milk.) 

Often the kidney will be found inactive, because, owing to conges- 
tion from cardiac trouble, it cannot act. Under these circumstances, 
digitalis, in 5 or 10-drop doses of the tincture, given three times a 
day, will be of value, and its efficacy will be increased by the addi- 
tion of 1 drop of the tincture of cantharides, if the renal lesion is ex- 
ceedingly chronic or mere torpidity exists. Digitalis and squill, in pill 
form, as follows, may be used : 

B . — Pulv. digital, fol. . . . . . gr. xx. 

Pulv. scillae . . . . . . gr. xx. M. 

Ft. in pil. no. xx. S. — One every five hours. 

Or digitalis and calomel may be employed in pill form in renal and 
cardiac dropsies. 

Caffeine is also a useful diuretic, particularly in torpidity of the 
kidney, as it stimulates the secretory epithelium, thus eliminating urea 
and other effete matters, and increases the passage of liquids by the 
increased blood-pressure which it produces. 

That a large amount of liquid may be gotten rid of through the 
skin under the influence of heat is well known. (See Heat.) In 
addition to external heat we may use pilocarpine by the mouth or 
hypodermically in localized dropsies, to produce absorption and con- 
sequent elimination of liquid by sweating. No drug should ever be 
given hypodermically in dropsy of a general character, as it will not 
be absorbed from the water-soaked tissues with any rapidity, if at 
all. 

The hydrochlorate of pilocarpine may be given in the dose of J to \ 
grain by the mouth, or \ to ^ by the needle. This method of re- 
lieving dropsy is often very exhausting, and should be most carefully 
used if cardiac depression or weakness is present. 

If dropsy depends upon deficient cardiac action digitalis will nearly 



DYSMENORRHEA. 453 

always do good. (See Digitalis.) If this is not used, citrate of caffeine 
will be found of service. 

Remembering that this form of dropsy is the result of failure on 
the part of the heart to do its work, we must use proper exercise, 
food, stimulants, and rest, combiued with fresh air and avoidance of 
mental worry. 

An infusion of scoparius, 1 ounce of the tops to a pint of water, 
taken in twenty-four hours, may be of service, and strophanthus, 
sparteine, and adonidin may all be used if any one of the drugs fails 
which are commonly employed. 

In hepatic cirrhosis, and in localized effusions of a chronic type, 
the best treatment for the removal of the liquid is the iodide of 
potassium, or tapping with a trocar and canula attached to an 
aspirating flask. 

Where the tenseness of the skin in the lower extremities causes 
danger of local sloughs, some authors recommend small punctures for 
the escape of the liquid, the limbs being incased in sterilized absorbent 
cotton to absorb the liquid. (See Acupuncture.) 



DYSENTERY. 

(See DlARRHCEA.) 

DYSMENORRHCEA. 

The existence of dysmenorrhoea depends upon so many conditions 
that the treatment employed in one case is seldom productive of 
success in the next. This is not the place for a consideration of the 
surgical measures adopted for the cure of this symptom, and only the 
medical treatment will be spoken of. 

When dysmenorrhoea results from the taking of a cold, and is 
accompanied by uterine congestion and irritability, the following 
measures are particularly valuable, and may do good in many cases 
depending upon other causes. The patient should take a hot sitz-bath 
and immediately get into bed as soon as the buttocks are dried, being 
well covered while in the tub, and afterward, by a blanket. A tur- 
pentine stupe is now to be used (see Turpentine), and 10 grains of 
Dover's powder to be administered, unless some idiosyncrasy toward 
opium is known to exist, when half or one-fourth of this amount may 
be employed. Often when the attack is accompanied by constipation, 
a purgative dose of Epsom salts or aloes is of service in the congestive 
forms of the disorder. 

If the pain is persistently severe, a belladonna suppository, of \ 
grain of the extract, may be inserted into the rectum, or, in other 
cases, belladonna ointment smeared over the os uteri will be found of 
service. The latter method is generally impracticable and is rarely 
resorted to. Very commonly belladonna tincture, by the mouth, is 



454 DISEASES. 

of service in relaxing the spasm of the cervix and of the uterine 
fundus. 

Some practitioners resort to the use of opium at each epoch, and 
keep the patient partially narcotized until menstruation is passed. 
This is unjustifiable and born of ignorance and bad practice, since the 
physician is simply dodging the trouble and predisposiug the patient 
to future attacks, by reason of the constipation and the resulting 
habit which is sure to appear after the employment of opiates. 

When the dysmenorrhea is due to obstruction of the cervical canal 
by organic changes or flexions, these conditions must, of course, be 
relieved before a cure can be expected, and the medical treatment can 
be directed only to the alleviation of the pain. Divulsions or slow 
or rapid cervical dilatation should be carried out by the use of instru- 
ments or tents. 

In neuralgic dysmenorrhea dependent rather upon nervous disorder 
accompanying menstruation than upon menstruation itself, measures 
directed to the improvement of the nervous system and the nutrition 
of the patient are necessary. These cases generally occur in nervous, 
anaemic women, run down by excessive dancing or other gaiety, or by 
the bearing and care of a large family of children. 

A course of strychnine or quinine and iron in small doses is often 
beneficial in these cases, and horseback exercise, between the men- 
strual periods, out-of-door life and avoidance of excessive dancing and 
exhausting exercise is to be ordered. 

Sometimes bathing the loins with alternate dashes of hot and cold 
water may do good in atonic patients. 

Cannabis indica and gelsemium are often of great service, both as 
cures and alleviators of the pain, and antipyrine, acetanilide, and 
similar drugs may be resorted to while the attack lasts, if it be 
neuralgic. 

When the pain seems to be greater than the patient can bear, enough 
ether may be given by the physician by means of inhalation to produce 
the primary stages of anaesthesia, but chloroform is not advisable, as 
the patient, if taught its value by the doctor, may resort to it without 
advice and die from an overdose. 



DYSPEPSIA. 

(See Indigestion.) 

DYSPNOEA. 

Shortness of breath, or dyspnoea, arises from cardiac weakness, abnor- 
mal innervation resulting in cardiac palpitation, from the accumulation 
of fluids in the chest, from the involvement of the lungs by any dis- 
eased process in such a way that respiration becomes impaired, or it is 
produced by indigestion, or, finally, by the encroachment on the lungs 
or chest-walls of tumors and growths. 



EARACHE. 455 

Each of these states must be removed to effect a cure, but it is only 
of the relief of the symptoms that we will speak. 

In old persons who sutler from dyspnoea, the result of bronchor- 
rhcea, where a large amount of liquid fills the bronchial tubes, and 
shortness of breath follows exertion, strychnine is the best remedy 
that we have. Its value depends upon its powerful influence over 
the respiratory centres, on which it acts as a stimulant, and as these 
cases very commonly also have dilatation of the right side of the 
heart, with consequent cardiac enfeeblement, strychnine is of additional 
service through its influence upon the circulation. These persons are 
not to be given opium or its alkaloids, or any sedative drugs, as such 
medicines, while giving temporary relief from cough, only serve to 
depress the respiratory apparatus and cause an accumulation of liquid 
mucus in the chest, as a result of the prevention of cough and lack 
of expectoration. The cases in which opium or morphine do good 
are those in which through nervousness or functional nervous disorder 
the respiratory cycle is imperfect, and, above all, in those instances 
where dyspnoea occurs as the result of cardiac disease. In these cases 
the attacks of oppression and suffocation can often be entirely set 
aside by the use of -J to \ grain of morphine given every night, or 
night and morniug. If these doses fail, larger ones may be cautiously 
used. Hyoscine, instead of causing sleep, nearly always makes these 
cases worse. 

Sometimes a little carbonate of ammonium is useful as a respiratory 
and cardiac stimulant in cases of dyspnoea. 

Dry cupping applied over the back of the chest may also be service- 
able when shortness of breath from cardiac or pulmonary trouble is 
present. 

In cases of dyspnoea due to emphysema and pulmonary inflammation 
of a chronic type, or in those persons who take cold on the slightest 
exposure, particularly after attacks of asthma, arsenic is useful if con- 
tinuously employed. 

If pleural effusion be present, relief of a positive and lasting nature 
can only be obtained through aspiration, or, in other words, by the 
operation known as thoracentesis. 



EARACHE. 

Earache is generally due to an acute inflammation of the middle ear, 
which has arisen either from exposure or by the extension of an in- 
flammation from the nasal cavities along the Eustachian tube. In 
any case, unless the patient already be a sufferer from chronic catarrh 
of the middle ear, the pathological process consists simply in an in- 
flammation of the mucous membrane lining these parts without the 
formation of pus, except in those instances in which the changes are 
very severe. 

The buzzing in the ears, followed by more or less severe pain, is to 
be relieved by measures which are known to allay inflammation. A 



456 DISEASES. 

leech may be placed in front or behind the ear, and heat is to be 
applied to the head on the side affected in a dry form, as in a bottle 
or water-bag. Poultices, oil and laudanum, and similar applications 
are not to be resorted to, as they may ultimately cause trouble and do 
not always produce temporary relief. 

Sometimes dropping a little water, as hot as can be borne, into the 
external auditory canal gives great relief if repeated as fast as the 
water cools. 

Cardiac sedatives are indicated, but quinine is distinctly contra- 
indicated, as it tends to cause aural inflammation. 

If a cold in the head is present, the patient must not use nasal 
douches of any kind, but the physician may employ with advantage 
a fine spray from an atomizer of a solution such as the following 
(Dobell's solution) : 

K. — Acid, carbolic, (cryst.) . . . gr. x vel xv. 

Sodii bicarb. \ 

Sodiiborat. J aa &" 

Glycerini . . f^j. 

Aqute q. s. ad Oij. M. 

Syringing the nostrils is a dangerous procedure except when per- 
formed by a specialist in ear or throat and nose diseases. 

Relief is often obtained by a spontaneous rupture of the tympanic 
membrane so that the secretion escapes, or, in other words, the ear 
" runs." If pus is discharged it is often very foetid. This accidental 
relief is no more to be waited for by the physician than is the rupture 
of an abscess, but when the drum is seeu to be bulging it should be 
punctured and the fluid allowed to escape. The mucus or pus must 
not be allowed to accumulate in the external auditory canal, but be 
frequently removed by swabbing it out with pieces of absorbent cotton 
on a probe or match-stick. If the discharge becomes adhesive it may 
be dissolved by the use of a drop or two of warm water or carbolized 
oil, 1 to 100. Sometimes the canal may be washed out by means of 
a very gentle syringing with salt and warm water, a teaspoonful to 
6 ounces. After each washing or cleansing finely powdered boric 
acid is to be blown into the ear through a goose-quill or powder- 
blower. 

ECZEMA. 

This is probably the most common form of skin disease which the 
physician is called upon to treat, with the exception of acne. 

Dermatologists divide it into many forms and stages, but in this 
book a consideration of its forms is out of place, and only the treat- 
ment for its stages is proper. 

In the first place it may be stated that the treatment is a quadruple 
one, namely, dietetic, hygienic, external and internal. 

In regard to diet, the patient should be told to avoid salt foods, 
such as salt fish or pork, and corned beef; greasy foods, such as bacon 
and fried dishes, pastry and cheese. Only moderate amounts of wine 



ECZEMA. 457 

and beer can be taken, and foods difficult of digestion are to be stricken 
off the bill of fare. 

In the way of hygienic measures, fresh air, the avoidance of seden- 
tary habits, horseback exercise, or walking is to be recommended. 
External treatment is the most important of the two measures in 
which drugs are employed, and its course is perhaps best described 
by taking a case of ordinary eczema as an example, and treating it 
through its entire course. 

In the early stages of an acute eczema, when the process is very 
active and the erythematous reddening of the beginning of the 
disease is merging into the formation of vesicles or pustules, with 
the formation of large scabs, no application is better than oxide of 
zinc ointment thoroughly applied night and morning. If the eczema 
be situated upon the scalp the hair must be invariably clipped short 
or shaved off in such a way as to prevent the gluing of the hair 
into a mat by reason of the discharge. The ointment may be smeared 
over the part or applied on a piece of lint in a thick layer. Nearly 
always the ointment should be used in conjunction with black wash 
(calomel 1 drachm, lime-water 1 pint), which should be applied twice 
a day just before the zinc ointment is resorted to, by means of a swab 
or a sop and allowed to dry. In other cases the powdered oxide of 
zinc is dusted over the part if the discharge is very watery and pro- 
fuse ; or the following ointment, recommended by McCall Anderson, 
is very efficacious : 

R. — Bismuth, oxidi . . . . ' . . ,^j. 

Acid oleic, pur. . . . . . . ,^viij. 

Cerse albse . . . . . . . ^iij. 

Petrolati jfix. 

Oleirosse 1TLv. M. 

Ft. in unguent. S. — Apply to the part affected. 

As the quantities of this prescription are large they may be reduced 
one-half for use in limited eczema. 

Where the proliferation of cells and the secretion are very profuse it 
may become necessary to remove the crusts before the local remedies 
can reach the skin, and for this purpose poultices may be used ; or, if 
the disease be on the face, the parts should be anointed with olive oil, 
containing 1 or 2 drops of carbolic acid to the ounce, to soften the 
crusts, which are readily removed in a half-hour by the use of a little 
castile soap and water. The soap is not to be used if the inflammatory 
action is very angry-looking. Whenever itching is an annoying fac- 
tor, the parts should be protected by lint smeared with some simple 
ointment, which may be carbolized both for its antiseptic and local 
anaesthetic effect. English and American dermatologists use what is 
known as liquor carbon is detergens very largely in the acute stages of 
eczema as well as in other skin diseases. It should not be used pure, 
but diluted in such a way that for each 4 ounces of water 2 drachms 
of the pure liquor are present. Liquor carbonis detergens is made by 
taking 9 ounces of tincture of soap bark (quillaia bark) and 4 ounces 



458 DISEASES. 

of coal tar, mixiug and allowing them to digest for eight days, after 
which the mixture is filtered and used. 

When the disease has passed from the acute, active inflammation of 
the first stage to the subacute form of the second stage of its existence, 
applications of a mildly stimulant character are necessary. Before this 
the physician has endeavored to soothe the parts ; now they must be 
excited to normal activity. For this purpose resorcin in the propor- 
tion of 2 to 30 grains to the ounce of lard, according to the severity 
and induration of the lesion in the skin, should be used. Stelwagon 
recommends the following : 

1$. — Unguent, picis liq. gj. 

Unguent, zinci oxidi gvij. M. 

S. — Apply to the parts. 

Where the disease is chronic and very persistent, but sluggish or 
atonic in its course, still more powerful remedies are necessary, such 
as salicylic acid, tar, or tincture uf green soap used with hot water 
until the skin beneath is bared, dressing this by means of zinc oint- 
ment or resorcin ointment, 2 to 10 grains to the ounce, spread on a 
cloth. The salicylic acid should be used in ,the proportion of 30 to 60 
grains to the ounce of lard, while the tar is used in the form of the 
pure official tar ointment. 

In seborrheic eczema where the secretion is greasy and dry, and fol- 
lowed, if wrongly treated, by oozing and the pouring out of serum and 
the formation of cells which form crusts, the following prescription is 
of value : 

R. — Kesorcin. gr. x vel xx. 

Pulv. arayli \ ... .. 
Unguent zinci oxidi J ° J ' 

Petrolati £ss. M. 

S — To be applied after removing the scabs by the use of a lotion composed of 
one part of bay rum and three parts of water. 

The internal treatment is directed to the cure of any disordered 
function which is present, such as dyspepsia (see Indigestion), hepatic 
torpor, general debility, anaemia, scrofulosis, inanition, constipation, 
gouty diathesis, or renal insufficiency. The gastric disorder is to be 
relieved by the use of hydrochloric acid and pepsin ; the hepatic torpor 
by mercury, podophyllin, or, better still, nitro-hydrochloric acid, of a 
deep orange color ; the debility by tonics, such as cinchona, cod-liver 
oil, strychnine, and bitters ; the anaemia by iron, and, if scrofulosis 
exists, by the syrup of the iodide of iron. Constipation is to be cured 
by the use of proper foods and laxatives, and the gouty tendency counter- 
acted by the employment of lithium citrate and colchicum, or potassium 
iodide. If the kidneys are at fault because of torpidity, the diuretic po- 
tassium salts, such as the citrate, are indicated. Arsenic is never to be 
used, except in those instances where the skin is very dry, and where, 
by improving digestion and through its alterative power, it does good. 
In the chronic forms of dry eczema or those depending upon some atonic 
state of the trophic nerves of the skin, arsenic is of great value in the 
form of Fowler's solution, or arsenious acid may be given. 



EMISSIONS. 459 



EMISSIONS. 



Seminal emissions occur as the result of sexual abuse, whereby a con- 
dition of hyper-excitation of the nervous cells in the spinal cord and 
the nerves of the genitalia is developed, or they are due to peripheral 
or centric irritations, which reflexly irritate the genitalia or the nerves, 
and to a number of other similar causes. These emissions also occur 
with some periodicity in normal males who are continent and chaste, 
and, under these circumstances, are not to be interfered with by treat- 
ment, unless the emissions become excessive. 

The former types are, however, proper for medical treatment, and 
their cure consists in the avoidance of unchaste literature and lascivi- 
ous thoughts during the waking hours, and the use of such spinal and 
cerebral sedatives that the centres governing the ejaculations of semen 
may be calmed, and so quiet a sleep produced that erotic dreams are 
avoided. The patient should sleep on a hard hair mattress, not be too 
heavily covered, and should avoid sleeping on his back, as this causes 
an undue blood -supply to the spinal centres, and consequent stimula- 
tion and ejaculations. Sometimes hard bodies, such as spools, are tied 
around the loins so that lying on the back will cause so much discom- 
fort that the patient awakes and turns on his side. The drugs to be 
used are bromide of potassium or sodium in 20-grain doses, at bedtime, 
or chloral may be taken in the same amount. Hyoscine has been most 
enthusiastically recommended by Wood in the dose of -j-J-^- grain. 
Sometimes a warm sitz-bath or general bath, before going to bed, is of 
service. In other cases, where atony is the cause of the trouble, the 
physician should recommend cold sponging of the perineum and loins 
night and morning. 

In the cases in which emissions come on as the result of continence, 
and become excessive, the remedies just named are to be tried, but 
really do not effect any permanent cure unless used until sexual power 
is seriously depressed, so that it has been the custom of many physi- 
cians to recommend " marriage/' which the patient may interpret in 
its legitimate light or not as he pleases. 

It is worthy of note that all irritations of the urinary bladder and 
other parts of the genito- urinary system should be removed, and it is 
often of value to administer citrate of potassium in 20-grain doses, 
in water, three times a day, to render the urine non-irritating and 
alkaline. Stimulating foods and drinks are to be interdicted, and 
condiments, such as pepper and mustard, avoided. 

Sometimes, when the emissions are caused by genital atony, strych- 
nine and arsenic are of very great service if given in full dose. 

In many of these cases it is the duty of the physician to treat the 
moral state of his patient as well as to give medicines. Many per- 
sons, believing that emissions are always an evidence of disease, read 
books on such subjects which are sold by quacks, and soon find their 
way to the hands of these persons or sensibly consult a regular physi- 
cian. Half the treatment in these instances consists in assuring the 



460 DISEASES. 

patient that he has nothing to worry about and in making him feel 
that the physician is his friend and worthy of all confidence and com- 
plete belief. 

ENDOCARDITIS. 

Endocarditis occurs sometimes as a single manifestation of disease ; 
sometimes as a symptom, with many others, of some general tendency, 
produced by a diathesis, such as gout and rheumatism, or syphilis. 
Further than this, it may be acute, subacute, or chronic, and each one 
of its forms must be differently treated. 

It is hardly necessary to state that any diathetic taint should be 
treated by an ti- rheumatic or anti-lithic remedies, such as the iodides. 
The iodides are not, however, indicated if any rapid changes of a de- 
generative type are at work. In acute sthenic endocarditis, associated 
with great vascular disturbance and much cardiac embarrassment, or 
irregularity, there is no remedy half so good in the early stages as 
full doses of tincture of aconite, 2 to 3 drops, given every hour until 
the physiological symptoms of its influence are felt, or, in its place, 
with equal efficacy, may be employed the tincture of veratrum viride 
(2 to 3 drops). At the same time calomel aud opium may be used ; 
the calomel for its antiphlogistic influence, and the opium to control 
the purgative tendencies of the mercurial. Thus we may use J grain 
of calomel every two hours and -^ of morphine. Leeches should be 
placed over the prascordium in a goodly number, and if these are not 
obtainable wet cups are to be employed. This depletion is only of 
service when the disease is seen early enough to make its abortion 
possible. As the disease progresses, if the physician fails to stop it, 
it will be found that the heart becomes somewhat labored in its action, 
irregular, and weak, and that its rhythm is seriously interfered with. 
At this time digitalis is of use in stimulating the depressed cardiac 
muscle and increasing its reflex activity, also steadying it through the 
pneumogastric irritation which it produces. Aconite and other de- 
pressants are contra-indicated at this time. Absolute rest upon the 
back is to be insisted upon, and it is recommended, in those cases 
where deposits of a calcareous nature are likely to occur in the valve, 
that the citrate or acetate of potassium be given, or that citrate of 
lithium be employed. If the disease becomes ulcerative, supporting 
treatment, consisting chiefly in the use of good food, and the tincture 
of the chloride of iron is of great value if the dose which is given is 
large. 

EPILEPSY. 

The disease known as epilepsy is probably the most disheartening 
condition as to treatment that the physician has to deal with, since it 
often resists the influences of all the staudard remedies, and drives the 
practitioner from drug to drug in the hope of finding one which will be 
,at least alleviating in its effects. For this reason the author has in this 



EPILEPSY. 461 

instance included the drugs which are rarely used, as well as those 
generally recognized as useful in its treatment, in order that the 
physician may try every remedy of any possible value. 

It should be borne in mind that the treatment of epilepsy is as 
various as the disease is variable in its forms and phases, and should, 
in nearly all cases, resolve itself into two or perhaps three divisions, 
consisting in the removal of auy exciting cause, in the checking of 
the convulsive tendency already set up, and in the prevention of any 
further attacks by suitable drugs or other measures of relief. 

The treatment is governed largely by the cause, and is medicinal or 
operative, according to the etiological factors at work. In simple 
idiopathic epilepsy medicinal means must be followed, while in a case 
resulting from traumatism, the depressed bone, abscess, or tumor must 
be removed, and in those due to reflex irritation, the peripheral source 
of trouble must be sought out and relieved. 

So far as drugs are concerned, the most valuable remedy in use for 
the relief of epilepsy is bromide of potassium, although other forms of 
bromide salts are to be mentioned later on. 

This drug, however, is not a " cure-all, " even in epilepsy, and re- 
ports are constantly made of cases where it has failed ; but many cases 
prove that the remedy is undoubtedly responsible for a cure when it is 
pushed in a suitable manner, and, in the vast majority of instances, 
the seizures are so decreased, both in violence and frequency, that its 
use may be said to be indicated in every case of the disease. 

In a very small minority, however, it signally fails ; and in a still 
smaller number of cases, it is useless unless combined with some other 
drug whose power alone is very slight. Nevertheless it is to be laid 
down as a rule, that the bromide treatment of epilepsy is, par excellence, 
the treatment to be employed on every occasion. There is no other 
drug known which can be relied upon so absolutely, or which is so 
powerful in its action and devoid of marked toxic effect, unless given 
in enormous doses. 

The doses to be used vary with the salt employed to a considerable 
extent, and depend upon the character of the disease and the tem- 
perament and physique of the patient. The greater the duration of 
the disease the greater is the difficulty in effecting a cure ; and the 
length of time which the man has been epileptic should therefore be 
most carefully reckoned before the treatment begins. Further than 
this, the frequency and severity of the attacks are to be looked into, 
and these points are really more important than the actual duration 
of the ailment ; since, if a man has only one fit every six months for 
twenty years, his condition is far less serious than if he has a history 
of three or four fits a day for one year. Again, the character of the 
attack, as to its violence, may be the most important fact to be 
regarded ; for if it is violent enough to endanger life, remedies must 
be pushed even beyond the point of tolerance. The writer has heard 
a very celebrated physician cause much amusement among his auditors 
by detailing an instance of an epileptic who was getting well, and would 
have recovered if he had not died. His explanation w r as, that the man 



4(52 DISEASES. 

was syphilitic, and was receiving moderate doses of iodide and bromide 
of potassium, which were slowly benefiting him, and would have cured 
him had not a single severe fit produced death in the meanwhile. 
Another point to be considered is the condition of the digestion, 
which the bromide of potassium is peculiarly liable to disorder, and 
which is sometimes so disturbed as to necessitate the administration of 
the drug by the rectum in serious cases. Females generally require 
smaller doses than males, and children of both sexes do not require as 
large quantities as adults. The dose to be used in the beginning of 
the treatment, in moderate cases, is about 10 grains thrice a day ; and 
while this may seem a very small quantity, it will be found that it can 
be rapidly increased in amount without causing the gastric distress 
produced by the sudden use of larger doses. Each day an additional 
ten grains may be added, until, at the end of a week, the patient is 
taking 80 grains in each twenty-four hours. There are very few cases 
which will not become completely saturated with the drug if this is 
done, and there are very few in which a more rapid arrival at bromism 
is needed. If, however, the patient has become able to stand large 
amounts, by the prolonged use of the drug, the amount given is not 
to be governed by grains but by physiological eifects, and it may be 
pushed to any amount which is borne without distress. 

In chronic epilepsy, too, with regularly recurring fits, the greatest 
good is obtained by pushing the drug in ascending doses for one week, 
and then, for the succeeding week, only enough is given to preserve 
the general effects of the medicament. By doing this the stomach 
gets a rest and the appetite is not greatly interfered with. Where the 
attacks occur only every two weeks, this is a particularly useful 
method for obvious reasons. As regards the time of day when the 
drug is to be taken, there can be no doubt. Some writers have 
directed that it shall always be taken before meals; but this is entirely 
lacking in advantage and decidedly fruitful of harm. Medicines 
which are given with the object of affecting the general system should 
be taken after meals, not before, and it is only when a local gastric 
effect is desired that we use them on an empty stomach, particularly 
when the substance is as irritant and depressing as potassium. If 
taken after meals the appetite is not decreased, but there are few who 
can take a dose of 10 or 20 grains of bromide of potassium before 
breakfast without suffering from indigestion. It has been held by 
some that the drug should be taken in minute doses, frequently repeated, 
in order to keep the patient constantly under its influence. This is an 
example of therapeutic ignorance, because bromides are slowly elimin- 
ated, and this frequent administration possesses the disadvantages of 
being inconvenient, annoying, and apt to disorder the stomach. 

If the attacks have a distinct periodicity, or can be foretold for as 
much as two hours beforehand, the remedy may be taken in a large 
dose only at this time, and but a few grains given in the intervals, 
and if the attacks are severe, no one should hesitate to use large doses, 
by the mouth, and by the rectum on the day of the attack. 

A very important point to be borne in mind, is that the drug often 



EPILEPSY. 463 

seems to have produced a complete cure ; and this results in careless- 
ness in the regularity of administration. The patient should be im- 
pressed by the fact that every day passed without a fit is a step for- 
ward, and that every fit carries him many steps backward. He 
should also be made to use the drug, in moderation, for at least three 
years after all fits have ceased, and to watch, after that time, for the 
slightest sign of their return. The quantity taken each day should be 
gradually decreased, not suddenly stopped short. 

It is true, also, that if a recurrence of the fits takes place they yield 
to treatment very much more slowly than before. 

Before passing on to the discussion of the other bromides, and the 
conditions produced by the excessive use of all of them, we may 
place our use of these compounds in epilepsy on a scientific footing. 
It is now generally recognized that the seizures known as epilepsy 
arise from the cells in the cerebral cortex, and there can be no doubt 
that the bromides act very powerfully upon the cerebrum in the 
higher animals, decreasing the irritability of the motor centres in 
these regions to a veiy great extent. Not only is this pointed to by 
clinical facts, but the well-known researches of Albertoni prove that 
such is their action beyond all doubt. This investigator found that 
the administration of a single dose of the bromide of potassium so 
lessened the excitability of the motor cells in the cortex cerebri that 
much stronger stimulation was necessary, in order to cause response 
in the limbs, than was normal, and that it was difficult to produce 
epileptic attacks by means of the electrical stimulation of the motor 
areas, even when currents very much stronger than those which com- 
monly produce such a result were used. He also found that this 
lessened irritability was increased still further if the drug was given 
for several days beforehand in such doses as thoroughly to impress the 
organism. It is, therefore, evident that the bromides act directly on 
the cortical areas, calming the tendency to explosions of nerve force. 

The results of Seppilli have also confirmed those of Albertoni in 
every way. 

An enormous amount of research has also proved that the drug 
may be doubly useful in reflex epilepsies, not only by its action on 
the motor portion of the cortex, but by its influence on the afferent 
portion of the nervous system. 

The experiments of Eulenberg and Gutmann prove that the 
sensory paths in the spinal cord feel more powerfully than any other 
portion of the body the effects of the drug ; for these investigators 
found that if they tied the bloodvessels supplying one limb of an 
animal, reflex action was abolished equally on both sides, proving 
that the loss of reflex action does not depend upon the action of the 
drug on the sensory nerve trunks. That the loss of reflex activity is 
not due to an action on the motor portion of the cord is proved by 
the fact that voluntary motion is completely preserved. As these ex- 
periments have been confirmed by Lewisky, Bartholow, Purser, the 
author, and Laborde, there can be no doubt of their truth ; and we 
can rest assured that not only does the drug prevent nervous dis- 



464 DISEASES. 

turbance in the cerebrum, but also that it prevents the peripheral 
irritation from travelling up to the brain, there to produce morbid 
excitement. 

Apropos of the theory that epilepsy is due to vasomotor disturbance, 
which is unfounded, it may also be added that the bromide of potas- 
sium was, and is, believed by some to effect a cure by producing a vaso- 
motor spasm at the base of the brain, but there is no basis for this 
idea, even if the disease were due to vasomotor changes. Hammond 
and Amory have seen the circulation in the brain slowed by the drug, 
and it has been claimed by Lewisky that if the toes of a frog be cut 
off, the blood flows more slowly from them in the poisoned animal 
than in the normal frog. None of these facts prove vasomotor action, 
but rather that there is a lessened circulation by reason of the cardiac 
depression produced by the potassium, for this element is known to 
have this influence. 

An important therapeutic point is to know how rapidly bromide 
of potassium is eliminated, so that we may know how frequently to 
give the drug. 

That it passes out of the body with only moderate speed is certain, 
for Rabuteau has noted its presence in the urine one month after the 
last dose, and Bill has found it in the same secretion two weeks after 
the use of the drug had ceased. 

Amory recovered, on the other hand, one-half the amount ingested 
in the first succeeding twenty-four hours, and one-third in the second 
twenty-four hours. It is evident, however, that it is eliminated so 
slowly that doses given three times a day make the patient ingest 
more than he eliminates. That bromide of potassium remains a long 
time in the system is proved by the fact that after repeated doses 
given to a healthy man marked somnolence persists for some days. 

There is one more point to which attention must be called, and that 
is the fact that when the bromides are taken for any length of time they 
produce bromism, which, in its moderate or severe forms, produces a 
mental condition very closely allied to that seen in old, chronic epi- 
leptics. This condition of the mind should never be overlooked ; and 
the ordinary mental changes of epilepsy are greatly increased by its 
constant and careless administration. 

The bromide salts of gold, iron, sodium, lithium, nickel, and am- 
monium have all been used in epilepsy with good results ; but, except 
in certain instances, they fail to act as well as that of potassium, unless 
given in larger doses. There are several circumstances, however, 
under which each one possesses marked advantages, and may succeed 
where potassium has failed. In all cases of epilepsy complicated with 
anaemia the bromide of iron should be employed ; but where there 
is plethora it will generally increase the disease or do no good. When 
it acts after potassium fails, the iron is of value, because of its tonic 
and nutritive effect. Bromide of sodium, while somewhat less powerful 
than potassium, is not by any means so apt to disorder the stomach, 
and is preferable in some cases on this account. It possesses no other 
advantages. 



EPILEPSY. 465 

The bromide of lithium has been highly recommended in intractable 
cases, by Weir Mitchell, who even states that it may be given in one- 
half the dose of the potassium salt with equally good effects. 

The bromide of nickel cures some cases where all other remedies fail, 
but this occurrence is rare. In a series of physiological experiments 
made by the writer some years since, he found it virtually identical 
with the potassium salt in its action, and it is useful in about the same 
doses and cases as is bromide of potassium. 

The bromide of ammonium is very irritant and disorders the 
stomach quite readily. It ought always to be used, when used at 
all, with some other drugs, the ammonium salt only acting as an 
adjuvant. 

Several clinicians have tried hydrobromic acid, but it is very much 
more apt to derange digestion and to produce vomiting than any of 
the salts. The dose of the dilute acid is J to 3 drachms in a tumblerful 
of sweetened water. 

The bromate of potassium has been used by Mitchell in doses of 
not more than 5 to 10 grains with good results, but is more dangerous 
and scarcely of greater value. 

There can be no doubt that in some instances what is known as 
the mixed treatment is successful when all else fails. This consists 
most commonly of a prescription in which the bromides of potassium, 
sodium, and ammonium take part. Why this combination acts better 
than any one of the salts alone no one know r s, but it is certainly a 
clinical fact. 

In other cases still, digitalis when used along with one of the 
bromides seems to produce favorable results. Indeed, digitalis has for 
years been used alone in epilepsy with fairly good results, and should 
always be used in obstinate cases. In petit mal, where bromide of 
potassium when used alone so often fails, it is useful, and several 
English writers, notably Gowers, assert that its best effects are in 
cases of nocturnal epilepsy. Why this should be the case no one 
knows, and it would seem doubtful whether it does any more good in 
nocturnal attacks than in others. Indeed, it is difficult to understand 
how digitalis can influence epilepsy at all, for its action on the nervous 
system is slight, save in toxic amounts, when it lessens reflex action 
very markedly, first by stimulation of Setschenow's reflex inhibitory 
centre, and later by paralysis of the spinal cord. This latter action 
never occurs, of course, from a medicinal use ; but in medicinal doses 
it may, by acting on the inhibitory centre, allay convulsive tenden- 
cies. Probably its chief action is through its circulatory influence, 
and further study may show it to be efficacious only in those cases 
where a heart tonic is required. 

Another combination very much employed and lauded is bromide of 
potassium with belladonna, the mydriatic being almost useless alone, but 
of great antiquity in its use in epilepsy. Like the mixture of digitalis 
and bromide, it succeeds very frequently in petit mal, and, indeed, seems 
to be much more successful than the digitalis, but its mode of action 
is exceedingly doubtful. As the drug acts even more powerfully upon 

30 



466 DISEASES. 

the nervous system than the circulatory apparatus, it has been thought 
that its influence for good depended upon this effect, but the experi- 
ments of Seppilli contradict this belief, for he found that if atropine 
was given to an animal the surface of the cortex cerebri responded 
more readily than is normal to electrical stimulation. 

At one time it was held that belladonna acted on the spinal cord 
and peripheral nerves under such circumstances, but it should be re- 
membered that we now know that atropine is only of value in relax- 
ing spasm when given in full dose, oftentimes hypodermically, and 
that Albertoni has made a series of experiments to determine whether 
it irritates the motor centres of the cortex. In his hands repeated 
small doses or one large dose in no way retarded the convulsions 
commonly produced by stimulation of the brain. Both these investi- 
gators are, therefore, in accord. Under these circumstances, it affects 
rather the motor nerve- endings than the central nervous apparatus. 

At the present time those who believe epilepsy to be dependent on 
cerebral vasomotor spasm rest the occasional good results obtained 
by the use of belladonna on its vasomotor influence ; but there is a 
good reason for throwing this idea aside, even if the morbid process 
named was really present, namely, that the drug in ordinary medicinal 
doses raises arterial tension by stimulation of the vasomotor centre, 
while it lowers blood-pressure only when given in toxic amounts, and 
then by an action on the bloodvessel walls. 

As long ago as the early part of this century cannabis indica came 
into notice in the treatment of epilepsy, and it is probably of greater 
value alone than when combined with any other drug, unless it be 
with the bromides. Although it is at present rarely so used, the author 
believes, from his own studies, that it is of value, for he found that 
it distinctly lessens reflex action and acts powerfully upon the higher 
nervous centres in the brain. Its use and value in migraine are un- 
deniably of the greatest importance, and epilepsy and migraine are 
often very closely allied. 

Gelsemium sempervirens is an American plant whose praises have 
been widely heard in almost every disease. Its influence alone is 
worthless, for it possesses no power over the cerebral centres whatever ; 
but in combination with cannabis indica it makes a very useful remedy, 
and depresses the conducting power of the spinal cord, while the can- 
nabis indica in its turn quiets the cerebrum. The dose of the tincture 
is 20 drops, but it should be remembered that it is as poisonous as the 
cannabis indica is innocuous. 

Owing to the soporific influences exercised by opium it has been 
very frequently tried, with both success and failure as a result. It 
certainly has not taken any rank in the list of remedies, and is de- 
servedly lacking in professional favor. It increases reflex activity 
very commonly, and seems to affect the intellectual centres of the cere- 
brum rather than the motor portions, although Seppilli's experiments 
show it to exercise a decided depressant influence over these areas. 
Combined with gelsemium it may be employed, but only when 
nothing else is at hand or all other remedies have failed. If it is so 



EPILEPSY. 467 

employed great care is to be used, and it should not be forgotten that 
both drugs kill by respiratory failure. When used in the " status 
epilepticus " it often does good in relieving the spasm, but it must be 
employed in large doses, and if the succeeding coma of epilepsy has 
added to it that of large doses of opium death may ensue. 

The employment of zinc, in its various salts, has been greatly recom- 
mended for many years, but has found little favor of late among the 
profession. It has been stated that it quiets the cerebral cortex, the 
medulla oblongata, and the spinal cord, and in this way cures the 
attacks. This is, however, merely clinical evidence, and has no ex- 
perimental proof to support it. Even its most sanguine supporters 
confess that the range of usefulness of zinc is generally in those cases 
where the bromides succeed, and agree that its powers are much infe- 
rior to these compounds. The dose of the oxide is 3 to 7 grains twice 
or thrice a day, and even in this amount it may cause nausea and 
vomiting. The citrate of zinc is more soluble, and is better borne by 
the digestive apparatus. Its influence over the disease is probably 
the same as that of the oxide, and this is also true of the lactate, 
which was so largely used by Herpin, and which is probably the best 
salt of ziuc to employ. 

Nitrate of silver was brought into use long before the value of more 
recent drugs was known. Everyone is agreed that it is without 
power for good, save when it was used constantly for a long time. 
As the drug is eliminated very slowly it rapidly accumulates in the 
body, and argyria soon comes on. It may be used, after all else fails, 
in doses of -J to J grain thrice a day after meals, the mucous mem- 
brane of the inside of the lips, and the conjunctiva, being carefully 
w r atched for the early signs of chronic silver poisoning. We certainly 
have no knowledge as to its influence on the nervous system ; and, if 
it acts at all, it must be by some alterative influences rather than by 
any other means. 

Nitroglycerin is to be employed in the treatment of petit mat rather 
than haut mat, in the dose of 1 drop of a 1 per cent, solution, once,, 
twice, or three times a day. Our knowledge of its effects, so far as its. 
curative influences are concerned, is very slight, but it seems to benefit 
some cases. Its action is very fleeting, aud it influences the brain very 
little, except it be taken just before an attack is expected, or when the 
cardiac action is defective. Its great lethal power should never be 
forgotten. 

The use of the nitrite of amyl is not for the purpose of directly 
curiug the disease, but of warding off impending attacks, the warning 
of which is given by an aura of slow progression. It increases the 
severity of petit mal, but in epileptics who have a prolonged aura we 
may use nitrite of amyl pearls, which consist in small glass beads 
containing a few drops of the drug. As the aura comes on, the 
patient should break one of these in his handkerchief and inhale the 
drug, thereby putting aside the attack. The influence which the drug 
exerts upon the brain is secondary rather than primary, and is proba- 
bly dependent on its action on the blood or circulation. Its influence 



468 DISEASES. 

on the spinal cord and nerves is much more marked and direct, and 
it is most certainly a very powerful spinal depressant. As its influ- 
ence over unstriated muscular fibre is very great it affects the vaso- 
motor system very powerfully ; and those who think epilepsy is due 
to a vasomotor spasm at the base of the brain point to the effects of 
this drug as a proof of their hypothesis. Such reasoning is not, how- 
ever, necessarily correct. Nitrite of amyl puts aside an attack by a 
sudden shock to the nerve centres, which diverts them, so to speak, 
from their intended discharge, very much as a ligature around the 
arm stops an aura. When we remember that the drug acts instantly 
and converts nearly all the oxygenating blood of the body into a non- 
oxygen-carrying fluid, by reason of the methsemoglobin produced, 
the sudden change in the cerebral nutrition and state is easily under- 
stood. 

In the treatment of the "status epilepticus" nitrite of amyl is of 
great value in stopping the seizures, and may be used under these cir- 
cumstances in heroic amounts, applied to the nostrils at intervals. 
During the presence of the tonic spasm, if it be severe enough to stop 
respiration, it should be remembered that if the drug is not inhaled it 
is absolutely worthless. It is only when respiration is being carried 
on that it can enter the luugs and do its work. 

As a general rule, the nitrite of ammonium or of sodium, both of 
which are prolonged in their effects, should be used internally to 
supplement the nitrite of amyl. 

Growers states that nitrite of amyl does good in epilepsy by flooding 
the brain with arterial blood. How such a statement can be made by 
anyone is amazing. Of all the drugs in the world, nitrite of amyl 
produces exactly the opposite change. 

The use of anaesthetics during an attack of epilepsy is virtually 
useless, and, in some cases, dangerous, for ether is too slow in its 
effects and may, by its irritant vapors, increase the tendency to laryn- 
geal spasm or cause lung complications. Further than this, if urseinia 
is the cause of the fit — and this fact is unknown in every case until 
the individual is carefully examined — the ether may increase the in- 
flammation of the kidneys very seriously. 

Chloroform, though it acts much more rapidly, may cause sudden 
cardiac failure, and both drugs may increase the post-convulsive coma 
very greatly. 

In "status epilepticus" they may be used, as in such cases the con- 
vulsions must be stopped at all hazards, but the preference should be 
always for amyl nitrite. 

The iodide of potassium is entirely useless in epilepsy unless the 
disease is due to syphilis, when it is of the greatest service. Indeed, 
the bromide and all other drugs should be set aside while this one is 
pushed to the utmost. As is well known, syphilitica usually bear the 
drug extremely well ; and the author knows of one instance where no 
less than 800 grains were taken every twenty-four hours with rapid 
improvement as a result. This point is strongly insisted upon by all 



EPILEPSY. 469 

therapeutists and syphilographers, notable among whom stands Four- 
nier. 

Where the convulsions are due to the presence of a gumma the 
iodide of potassium is, however, too slow in its action and should be 
associated with mercury in order to break down the growth without 
delay, lest a seizure cause death by glottic closure producing asphyxia 
or some similar accident. 

Some difference of opinion exists as to the usefulness of iron in 
epilepsy. Several very eminent clinicians have asserted that it always 
makes the attack worse, and therefore does more harm than good. 
Like everything else, iron is no more to be given in every case than 
is a dose of oil ; when there is plethora it is. harmful, and when there 
is malnutrition and anaemia it does good. Over the disease itself 
iron has really no effect at all, except through its action on the general 
system. 

Chloral hydrate is a remedy which has been only partly tried in 
epilepsy, and its usefulness is not as yet determined. It possesses the 
marked disadvantages, as compared with the bromides, of being a very 
fatal poison, which is an important fact to be borne in mind by the 
physician when giving it to a patient whose mind, already weakened 
by the disease or naturally stupid, may forget and take too much. Its 
physiological action indicates much more fully that it may be of value 
than does that of many other much more lauded remedies, since it 
exerts its chief influence on the motor pathways of the spinal cord 
and quiets the motor portion of the cerebral cortex and also produces 
sleep. Seppilli has proved this, by direct experimentation after the 
method employed by Albertoni. Its use, combined with one of the 
bromides, is often accompanied by the most desirable results, and it 
should be tried at all times unless some cardiac complication forbids 
it. It may disorder the stomach, and should, like the bromides, 
always be given well diluted and after meals. 

Of the more recent remedies, acetanilide certainly stands in the fore- 
most rank, and bids fair in some instances to rival the bromides. 
Professor Germain-See, the author, and some others have reported 
cases which obtained very marked relief from it, and more recent 
investigators have done likewise. The drug will be found to exert 
its chief benefits in chronic epilepsy. At least, if a child was brought 
to the author with a beginning epilepsy, he would use the bromides, 
but if the disease was chronic, acetanilide. 

Antipyrine has also been pushed forward as a remedy, and its 
physiological action on the nervous system is virtually identical with 
acetanilide. 

Antipyrine has been recommended by Lemoine in certain forms of 
epilepsy, but condemned in most cases. In those who suffer from 
menstrual epilepsy, so called, or in those in whom the attack is pro- 
duced reflexly by the presence of intestinal parasites, the drug does 
good. 

Lemoine also found it very useful in those cases which are asso- 
ciated with migraine. In these cases the results were better than 



470 DISEASES. 

with the bromides, but in the idiopathic simple varieties it was useless. 
Mairet and Combemale have used the drug in the epileptiform mania 
with satisfactory results. 

In children suffering from frequently recurring epileptic attacks the 
presence of worms should always be looked for, and when they are 
found they should be expelled as rapidly as possible. If they are the 
oxyuris vermicularis (seat-worms) the best remedy by far is the injec- 
tion of a strong infusion of quassia of such a strength that there are 
2 ounces of quassia to each pint of water. 

In girls, where the removal of the worms from the rectum is not 
followed by relief, a careful examination of the vagina should be made 
and quassia employed in somewhat weaker solution, as very commonly 
intense inflammation is there present, produced by migratory move- 
ments of rectal parasites. If the quassia is unobtainable in any case, 
a saturated solution of chloride of sodium may be employed. 

The treatment of epilepsy by borax has not received very wide re- 
cognition. Perhaps the most thorough studies of its effects have been 
those of Gowers in England, and Folsom in America. It would 
seem that some cases which are obstinate under ordinary treatment, are 
benefited by borax, but it is certainly not to be commonly employed. 
The dose generally given is about 15 grains. 

Having spoken of the drugs which may be given to epileptics, 
attention may be drawn to those which may not be used. There is a 
very large amount of reliable evidence, both experimental and clinical, 
that quinine should never be employed in these cases when it can be 
avoided. Thus Seppilli, in his researches, found that it increased the 
irritability of the cerebral cortex, and Briquet has asserted that it is a 
direct cerebral stimulant. That toxic doses of quinine may provoke 
epileptiform convulsions has been proved by Jakowbowich, who has 
seen them occur in cinchonized dogs and other animals, and Brown- 
Sequard and Albertoni have noted that cinchonidine and quinine 
always increase the number of attacks in epileptics. 

Salicylic acid, too, has an effect upon the brain very closely allied 
to that of quinine, and should always be used with care in cases of 
epilepsy. Professor Germain-See has also pointed out that large doses 
of this drug produce violent epileptiform convulsions in the lower 
animals. 

Strychnine, while its chief effect is to heighten the activity of the 
spinal cord, also, according to Seppilli, increases the irritability of the 
cortex, and should be employed only in peculiar cases. The same 
writer also found that absinthe and picrotoxin predispose to epileptic 
seizure by increasing the excitability of the motor zone of the cerebral 
cortex. 

Bleeding the patient in epilepsy, unless there is marked evidence of 
cerebral congestion, which is exceedingly rare, is harmful rather than 
of value. Orschansky found that removal of one-seventh of all the 
blood in the body by the femoral vein did not lessen the irritability 
of the cortex, and Minskowsky ligatured all the bloodvessels going to 



EPISTAXIS. 471 

the brain without decreasing its excitability. We know also that 
cerebral ansemia produces epileptic attacks. 

A very important point, which is constantly brought before the 
physician who is treating epilepsy, is that of diet. Nearly every 
patient who suffers from this disease inquires what he shall eat. Very 
few researches of a thorough character have ever been carried out 
on a large scale to determine the things which may or may not be 
ingested. Of course, nearly every one of us knows from our personal 
experience that red meats are hurtful, particularly in children. 
Curiously enough, the influence of diet in one research covering a 
number of cases of chronic epilepsy, seemed to be of little moment. 
Thus, Merson examined twenty-four such cases, putting twelve of 
them on a purely vegetable, and twelve on a purely nitrogenous diet. 
The result, after this study had been continued for two months, was that 
the vegetarians had had a few less fits than the others, but the difference 
was so slight as to be of almost no weight in determining the question. 
Some authors at the present day believe this opinion as to the harm- 
fulness of meats to be erroneous, and Gowers is oue of them. 



EPISTAXIS. 

Nose-bleed depends upon many causes, the chief of which are trau- 
matisms, plethora, and the presence of ulcerations in the nasal cham- 
bers. It also occurs as one of the prodromata of typhoid fever. 

Probably plethora is the most frequent cause of nose-bleed, and in 
most instances the latter is an attempt on the part of the system to rid 
itself of an excess of blood. Under these circumstances epistaxis is 
not dangerous, nor is it proper to arrest it unless it becomes excessive. 
Where it is excessive, or must be controlled for any reason, the meas- 
ures to be adopted are both medicinal and non-medicinal. If the person 
is full-blooded and strong, full doses of tincture of aconite or veratrum 
viride are useful, say 2 to 4 drops of one of them, followed in a half- 
hour by a smaller dose, if necessary. The value of these drugs de- 
peLds upon their power of lowering blood-pressure, and in consequence 
decreasing the leakage from the solution of continuity in the blood- 
vessel. Some physicians have recommended ipecac in full nauseating 
doses to relax the arterial system. Powdered alum, pure, or half and 
half with starch, or in solution, may be suuffed up the nostril, and 
tannic acid, in powder or in solution, may be used with advantage. 
If this does not control the haemorrhage an atomized spray of Mon- 
sel's solution, in the strength of 30 drops to 4 ounces of water, may 
be of service. Ergot in the form of the fluid extract in the dose of 1 
drachm may be given, or its wine in the dose of a wineglassful em- 
ployed. Sometimes, when the oozing is slow, doses of turpentine taken 
internally, oil of erigeron, or hamamelis, do good. As a household 
remedy, vinegar may be injected into the nostrils, or lemon-juice may 
be employed in the same way. 

All these remedies act as styptics when locally applied, by causing 



472 DISEASES. 

coagulation of the fibrin and the formation of a clot, while the internal 
remedies produce local contraction of the bloodvessels in the congested 
area, this area being more susceptible to the influence of these drugs 
than the rest of the vascular system. 

The non- medicinal measures to be employed, if the bleeding is severe, 
consist in plugging the anterior nares with pledgets of cotton or pieces 
of lint soaked in vinegar. If this does not control the haemorrhage, 
the posterior nares may also be closed by plugs, and compression of the 
facial artery, of the same side as the bleeding nostril, be made upon 
the superior maxilla near the nose, thus decreasing the blood-supply. 
The head must be kept raised and the patient must not bend over a 
basin or wear a tight collar. 

A piece of bacon fat cut to fit and placed in the nostril may stop 
epistaxis which has resisted all other measures. 

Sometimes, if the patient raises one or both hands high above the 
head, the haemorrhage ceases. This is due to the fact that the easiest 
pathway for most of the blood is straight up the brachial arteries 
rather than through the tortuous vessels of the face. A hot foot- 
bath, by dilating the veins of the lower extremities, draws away the 
blood from the face and is a useful measure. In other cases, a hot- 
water bag applied over the dorsal vertebrae is efficacious, and some- 
times cold when so used is of service. A piece of ice pressed against 
the nose may prevent further haemorrhage, by causing localized 
anaemia. 

Where the nasal haemorrhage results from traumatism, with fracture 
of the bones, and great loss of blood ensues, ligation of the bleeding 
vessel or its supplying vessel should be, if possible, resorted to. 



ERYSIPELAS. 

This disease is now being studied very widely, because of the gen- 
eral recognition that it is dependent for its existence upon a germ. 
The streptococcus of erysipelas is practically identical with that of pus, 
and the disease is at first a distinctly local one. The changes which 
have come forward in its treatment are chiefly the local measures, 
while those methods which have been used interually for many years 
have suffered no alteration. 

Whether or not erysipelas is a local or systemic disease has little 
to do with the proper treatment. In any case it is an inflammation, 
and as such it must be treated. In its early manifestations and where 
some uncertainty may exist as to its true character, aconite or vera- 
trum viride may be used in sthenic cases in which the nervous and 
circulatory systems give evidence of reflex irritation, and the pulse is 
hard and full. Those remedies are contra-indicated if any tendency to 
weakness exists. Da Costa has recommended, and others have carried 
out with success, the practice of using pilocarpine in sweating dose (J 
to ^ grain hypodermically), in these early stages, and in some instances 
the injection may be made at the margin of the inflammation with 



ERYSIPELAS. 473 

advantage, as this method seems to control the development and spread 
of the disease. The objection to the use of these injections about the 
inflamed area rests in the possibility of the formation of a slough, 
which when infected would speedily change a superficial lesion into the 
phlegmonous form of the disease. As with aconite and veratrum 
viride, it is to be remembered that this use of pilocarpine is not to be 
resorted to if debility exists. When asthma is present, or the disease 
is too far advanced to be aborted, belladonna in the dose of 3 to 5 
minims of the tincture every four hours should be used. It may also 
be locally applied on lint with benefit, or belladonna ointment may be 
smeared on the skin. 

The internal treatment of erysipelas par excellence is the plentiful 
use of the tincture of the chloride of iron — 20 to 30 drops, or even 
40 drops, four times a day. The diet should be regulated and the 
bowels kept in good order, while any excessive febrile movements are 
to be treated by the use of antipyretic drugs such as antipyrine — 
better still by cold bathing. Where the patient passes into the 
typhoid state, supportive measures must be used and alcoholic stimu- 
lants added to the food, which should be predigested or prepared so as 
to be readily absorbed. 

During convalescence the use of tonics, both in the form of iron 
and bitters, is particularly indicated, if the recovery of strength is 
slow. The local treatment of erysipelas is very varied, but in the 
majority of cases resort need be had to but one or two methods. 

By far the best dressing for the general run of cases of erysipelas is 
a modification of that of Von Eussbaum, which the author has tried 
in a number of cases with great success. The skin of the part in- 
volved is carefully cleansed with castile soap of the purest form, which 
is washed off by a 1 to 1000 solution of bichloride of mercury. The 
skin is dried with a soft towel and a thick coating of ichthyol and 
vaseline or lanolin applied, the strength of this ointment being half 
and half. Over this is placed antiseptic gauze or sterilized absorbent 
cotton and adhesive strips, or a bandage is used to keep the dressing 
in place. Sometimes the ointment alone may be applied if the area 
is small. Under this treatment the results are often extraordinary, 
in all stages of the malady. Where ichthyol is not obtainable, a 
thick coat of white-lead paint, as it is sold in cans before it is mixed 
with any thinning substance, will be found of service in an emer- 
gency. 

The plan recommended by Higginbottom, of applying nitrate of 
silver, is often successful. It cousists in the use of a solution of the 
strength of 80 grains to 4 drachms of distilled water, which is thor- 
oughly applied with a camel's-hair brush over the entire inflamed 
area, and for a little space beyond. The application must be made 
twice or thrice to secure a good coating. This treatment will often 
arrest the inflammation and prevent its spread, but has caused 
sloughing. 



474 DISEASES, 



EXHAUSTION AND DEPRESSION. 

While the treatment of both these conditions is almost identical in 
some respects, it is, nevertheless, important that a clear idea of the 
difference between the two be clearly understood, if for no other 
reason than that the physician may recognize that exhaustion is a 
far more serious state than depression. It also requires more careful 
treatment. The man who is depressed retains in his body all the 
vital forces necessary for the maintenance of life, but they are tem- 
porarily in abeyance from some cause. As soon as the incubus is 
taken away, the system at once asserts itself and recovery takes place. 
This is not the case with a man suffering from exhaustion. In this 
patient every particle of his strength is sapped and lost. The mau 
depressed is the giant lying unconscious from a blow on the head ; 
the man exhausted is the same giant after a long attack of typhoid or 
other fever of a similar nature. . The treatment of depression is 
stimulation ; of exhaustion, not only stimulation, but feeding and 
protection from exposure. 



FEET— SWOLLEN, TENDER, OR SWEATING. 

These comparatively simple, yet annoying, conditions are often 
brought before the physician for relief, and patients suffering from 
them will frequently be more grateful for skilful treatment than in 
the event of recovery from a severe illness. 

Swelling of the feet occurs chiefly in two classes of cases, excepting, 
of course, in dropsy, which makes a third class. These are old per- 
sons taking too little or too much exercise, and who may have gouty 
or rheumatic tendencies, and those who, by constant standing or walk- 
ing, cause congestion of the lower extremities, chiefly by fatigue, or 
by wearing bad shoes, or by running over uneven ground, causing 
bruising. Where the swelling takes place in the first class, small 
doses of arsenic, in the dose of -^ to -fo grain, often do good, and 
careful examination should be made of the circulatory, renal, and 
respiratory apparatus to discover any weak points, such as vascular 
relaxation or tendencies to varicosities. The distilled or fluid extract 
of hamamelis is often of service in the dose of J to 1 drachm of the 
former and 10 to 20 drops of the latter preparation. In some cases 
absolute rest of the feet will be necessary before cure is reached. 

Where the feet are tender the most common cause is bruising from 
too thin soles on the shoes, too tight shoes, and from abrasions or skin 
disease. More commonly than all, they become sore from excessive 
sweating and resulting maceration. 

The treatment of sweating and tender feet is, of course, the removal 
of the caus^e and the use of remedies designed to toughen and harden 
the skin of the parts. Probably the best application for this purpose 
is a solution of salicylic acid and borax, half and half, in water and 



FEVER AND ITS TREATMENT. 475 

glycerin, rubbed over the feet night and morning. If the sweating is 
very severe, the stockings worn should be clean each day, and pre- 
viously soaked in a strong solution of borax and dried. The follow- 
ing prescription affords a useful powder : 

R • — Pulv. acidi salicylic! . . . gr. xx vel xl. 

Pulv. acidi borici • . . . . % ij ■ 

Pulv. amyli q. s. ad %]. M. 

S — To be dusted over the feet night and morning, after washing and thoroughly 
drying them. 

Sometimes the use of cotton instead of woollen stockings may 
aid in the cure. 



FEVER AND ITS TREATMENT. 

{For the Treatment of each Fever, see its Title.) 

At the present time the medical profession are almost universally 
of the opinion that fever is a disorder of calorification dependent upon 
nervous action, said nervous action being the result of various causes, 
such as the presence of poisonous materials in the blood, or of per- 
verted functional activity. The first may be represented by the fever 
of any infectious disease ; the second by the so-called hysterical hyper- 
pyrexia. Turning from the general question of fever to those drugs 
which combat it, we are met at once by an array of synthetically pre- 
pared substances which are almost without number, and which are 
derived chiefly from the tar found always in close proximity to deposits 
of coal. 

The value of a drug which can decrease high temperature by in- 
fluencing heat-production alone cannot be over-estimated, and while 
several drugs seem to influence this part of the heat apparatus more 
than that portion connected with the dissipation of heat, we have no 
substance which is distinctly and solely capable of exercising an in- 
hibitory power over the development of heat in the body. Frequently 
one of the substances put forward by its discoverer as a useful anti- 
pyretic remedy has been found so to depress the heart or respiration 
that it cannot be used, while others produce secondary lesions in the 
tissues of the body by more slowly acting influences. For both ex- 
perimental and practical purposes we may, therefore, divide anti- 
pyretics into three great classes : First, the substances which allay or 
prevent fever by inhibiting its production ; second, the drugs which 
possess the power of decreasing bodily temperature by increasing the 
dissipation and decreasing the production of heat; and third, the 
compounds which allay fever, not by stopping the manufacture of 
heat units, but by so increasing the exhalation of heat that the loss 
is greater than the manufacture. The first and last of these three 
classes are directly opposed to one another. The second class is half- 
way between, and it is to this class that most of our antipyretic drugs 
belong. The first is the ideal, the second is the one we have to be 



476 DISEASES. 

content with ; the third is the one used by our forefathers, and is the 
most dangerous and unreliable, since the tissues are quite as rapidly 
destroyed as before the drug was giveu ; the centre of the body re- 
maining in pyrexia, while the cool skin and extremities are apt to 
lead the physician into the belief that the fever no longer exists. 
The tissue-waste of the fever goes on unchanged, and the patient, if 
the disease be prolonged or asthenic in character, is in almost as bad 
a condition as when no such antipyretic attempt has been made. 
Almost as badly off, because it should never be forgotten that hyper- 
pyrexia, or even ordinary fever, is dangerous in two ways, namely, 
by destroying tissue and reducing vital power, and by acting simply 
as too great bodily heat, and thereby producing nervous or cardiac 
symptoms, such as are seen in cases of sunstroke and heat-exhaustion, 
where the condition of the patient is the result of coagulation of the 
cerebral or cardiac protoplasm, or is one of depression of all vital 
function. 

Closely allied to this question is that which asks us to define what 
we mean by hyperpyrexia. As given by most workers upon fever 
this term is applied to any state in which the temperature reaches 
106° or 107° F. ; but in reality this has nothing to do, except in an 
indirect way, with what the student or physician wishes to know. 
This is but another example of the fact that the presence of a high 
temperature alone does not constitute the sole indication for the 
treatment of the disease, the physician being governed by the state 
of the patient who is laboring under the malady. A temperature of 
106° F. in a young healthy man, suffering from an attack of some 
short-lived disease, does not mean very great danger ; but a tempera- 
ture of 103° day in and day out in typhoid fever does mean danger, 
and must be carefully attended to. In a simple continued fever 
106° F. is a hyperpyrexia. The question is one not of actual degrees 
Fahrenheit, but rather as to whether the temperature present is doing 
any harm. 

Turning to the drugs, which are divided into classes, named from 
their physiological effects, we may, in view of our present knowledge, 
place them as follows : First, those which decrease heat-production 
alone are not known. Second, those which act both on dissipation 
and production are antipyrine, acetanilide, carbolic acid, salicylic acid, 
similar substances, and quinine. In this class, also, should be placed 
cold bathing, which probably decreases heat-production as well as in- 
creases heat-dissipation. Third, those drugs which only dissipate heat, 
as far as we know, namely, the great group of cardiac sedatives and 
their allies. 

No one is more sensible of the fact than the writer that this 
arrangement of the subject is partly artificial, but in the present state 
of our knowledge it is probably the best we can do. 

Though a number of writers have claimed that certain antipyretic 
remedies of equal power act with different results in different diseases, 
the writer has never been able to see any such distinction, and we 
must be guided rather by experience as to the value of some particular 



FEVER AND ITS TREATMENT. 477 

antipyretic in all diseases thau by any other rule. All observers are 
not in accord, however, as to the best one of this class. While 
phenacetine has been spoken of very highly by some authorities, the 
writer has heard it equally condemned by others, and although Ringer 
prefers antipyrine, Mitchell Bruce relies chiefly on acetanilide, while 
in America almost everyone prefers the former drug, the general 
diffusion of this preference apparently resting upon wide experience. 
Though the number of cases of ill-effects recorded are small with acet- 
anilide as compared with those of antipyrine, the idea prevails, and 
perhaps justly too, that the former is much more capable of harmful 
effects than the latter, and it cannot be denied that scientific basis of 
great weight exists for this belief. 

It may be said that we have only three measures for the relief of 
fever which are reliable and have stood the test of time. These are 
antipyrine, acetanilide, and the use of cold. (For the mode of using 
antipyrine and acetanilide see pages 42 and 72, and for the use of cold 
see page 353). 

For many years the profession of medicine has been in the habit of 
feeling the pulse with the perfectly proper object of determining what 
the state of the system is as it appears on this sign-board of the body, 
but it has only been of late, when our knowledge has increased, that 
we have come to consider the pulse rate and force as something more 
than a simple aid to diagnosis. At present many seem to forget that 
the very value of the pulse, as a sign-board, depends upon its readi- 
ness to obey the beck and call of the variations in the body, and to 
consider that, in fever, for example, the pulse is rapid, not because 
the fever makes a rapid pulse, but that a rapid pulse and fever are 
equally dangerous conditions, both of them of primary importance ; 
in other words, these persons regard the rapid pulse, not as the result 
of a high temperature, but as a symptom in itself. 

While in our present state of knowledge concerning the poisons 
which produce fever we cannot assert that none of them act on the 
heart in the same manner as do certain drugs, thus altering the pulse 
rate and force, we are able by experiments to prove that high tem- 
perature of itself does seriously alter the heart-beat, and, in addition, 
that antipyretics, as a general rule, in lowering the fever lower the 
pulse, not directly, but indirectly. Such results are to be gleaned 
from the studies of Lauder Bruuton, Newell Martin, and several 
other workers in this field, who have found that febrile temperatures 
stimulate the accelerator cardiac nerves. 

Closely associated with this question is that of the relationship be- 
tween arterial pressure and fever. It at once becomes evident that, 
if heat stimulates the accelerator nerves, an increased rapidity of car- 
diac action must ensue, and, in consequence, an increase in the amount 
of blood thrown into the arteries must result. As a consequence of 
this the arterial pressure must rise, even if the vasomotor system gives 
response in no way to the heart. In nearly all cases of high fever, 
however, unless the system be greatly exhausted, the vasomotor appa- 
ratus certainly is excited to increased activity. 



478 DISEASES. 

As the writer has spoken of the dangers of high fever, it is not right 
that the impression be given that everyone believes with Liebermeis- 
ter in the absolute harmfulness of such states. While the profession in 
general accept such views, the opponents to them, though not great 
in number, have been so prominent, as individuals, that their studies 
cannot be passed by. In 1883 Unverreicht tried to rebut the testi- 
mony then so rapidly accumulating in favor of antipyretic measures, 
and, still later, Naunyn, in a very carefully written and logical paper, 
positively denied their value and usefulness. While he grants that 
high temperatures are most important in prognosis and diagnosis, and 
that certain antipyretic measures do good, he, nevertheless, insists 
that, though the cold bath does good primarily, its effect upon the 
nervous system nullifies its direct action upon the fever. He acknowl- 
edges, of course, that such temperatures as 108° or 110° F. are of 
dangerous import in themselves. To prove that his assertions are 
correct, Naunyn gives results reached in a series of studies made by 
him on animals. He found that healthy rabbits will bear a tempera- 
ture, artificially induced, of 106° to 107° F., rising at times to 108° 
to 109° F. for days together, without any injury. He further states 
that in many autopsies he has failed to find any lesion present as the 
result of exposure, except a slight cloudiness of the renal epithelium. 
The author cannot help calling attention to two facts which Naunyn 
apparently overlooked, in common with many of the readers of his 
paper, namely, that 106° to 107° F. is only a few degrees above the 
rabbit's normal heat, which is about 103° F., so that the pyrexial tem- 
perature of these animals corresponded to but 101° or 102° in man, a 
temperature easily borne in many fevers. Second, it should be remem- 
bered that this heat was applied constantly in these studies to the 
animal, which did not have to manufacture the heat itself. Although, at 
first, this seems unimportant, it should not be overlooked, as the tissue- 
changes in the two instances are entirely different ; to use a homely 
simile, in one case the stove is kept warm by heat applied to it exter- 
nally without the combustion of its tissues, the coal ; in the other 
case, the stove is kept hot by the use of the coal itself. Very different 
changes are naturally found in the two cases in the coal. The author 
cannot go further into these questions ; suffice it to state that while 
high temperatures are borne in some instances with no evil results, the 
majority of cases do not turn out so favorably. 

The various opinions expressed by well-known German clinicians 
concerning this question have been collected by Ziemssen. Speaking 
of the worth of antipyresis in any form, he divides the writers of the 
last twenty years into groups, as follows : First, the extreme hydri- 
atricists who only use cold bathing and object to internal antipyretics 
— such as Vogel, Winternitz, and others. Second, the moderate 
hydriatricists, who resort to lukewarm baths, but reject internal anti- 
pyretics, among whom may be named Naunyn and others. Third, 
those who, according to indication, resort to moderate hydropathy and 
to antipyretics, such as Jurgensen and Reiss. Fourth, those who 
consider fever as a salutary and necessary regulator, and only resort 



FEVER AND ITS TREATMENT. 479 

to antipyretics when dangerous symptoms arise — as Heubner, Cursch- 
raann, and others. Fifth, those who claim that fever is a necessary 
phenomenon, and therefore reject all attention to antipyresis and 
attend to diet (Glaser). Finally, those who absolutely deny the in- 
fluence of treatment on the mortality of fever (Port). 

Truly, it would be hard to find a set of more diverse and contra- 
dictory opinions on so limited a basis, but the practice of Jiirgensen 
and Eeiss has virtually proved the value of antipyretic measures, and 
they are resorted to by most of us. Those who have tried them rely 
on this method very largely, and they are certainly an advance in 
therapeutics. 

A very important question arises as to the value of the cold bathing 
in private practice. There can be no doubt of its acting well under 
these circumstances if carefully carried out, and it is certainly much 
the best remedy for fever where trained nurses are on hand to admin- 
ister it, but where only members of the family are in care of the sick 
man, and where the doctor can only be on hand once in twenty-four 
hours, it is manifestly impossible to resort to it. Even if the bath be 
properly given, the exhaustion produced by clumsy handling may 
more than counterbalance all the good achieved. It has been claimed 
that the cold pack never results in cardiac failure, as does the use of 
antipyretics. We are quite confident of the fallacy of this statement. 
Indeed, the writer has recently seen such a case. The cold pack 
cannot be used more carelessly than antipyretic drugs, and it is prob- 
able that when this measure is more widely employed more reports 
will appear in the medical magazines of accidents occurring as the 
result of its abuse. (See Cold in Fevers, p. 352.) 



Sthenic Fevers. 

The application of antipyretics to the febrile temperatures occur- 
ring in sthenic cases has an entirely different purpose from their 
employment in a prolonged low fever of the adynamic type. There 
can be little doubt that in the sudden excessive outbursts of febrile 
temperature in a child from functional disorder but with no acute 
disease underlying it, antipyretics are of great value, and there are 
also reasons for their employment in the treatment of children and 
adults in order to favor popular prejudice. In America, at least, a 
physician visiting a case of croupous pneumonia for the first time and 
finding the patient with a high fever would not be allowed to give 
the patient a cold bath if the friends could prevent it, and he must, in 
consequence, fall back upon antipyretics. Again, the fever of such 
cases cannot be prolonged enough to necessitate the use of antipyrine 
day in and day out for weeks at a time, and there is, for this reason, 
less danger of the patient being injured by its influence. In scarlet 
fever the use of such drugs should be most carefully watched, because 
the kidneys are in danger and the disturbances accompanying the fever 
may last a long time. 



480 DISEASES. 

Iii pneumonia and erysipelas in strong persons antipyretics find 
their true place. Lasting about a week in their febrile activity, these 
diseases are often accompanied by sudden hyperpyrexia which must be 
overcome at once by a drug, and the temperature is so apt to rise at 
any time to a dangerous degree that some remedy often has to be left 
in the hands of the nurse with instructions to use it if a hyperpyrexia 
should assert itself. Even in these cases the cold is the best remedy, 
but the physician must be careful to see that it is properly applied, or 
it will be harmful instead of useful. 

In thermic fever, or sunstroke, the employment of antipyretics is 
often useless. The excessively rapid upward rush of the temperature 
responds in no way to drugs, and there are cases on record in which 
the use of antipyrine has utterly jailed of good result. Thus, in one 
case reported by Singer, a man suffering from thermic fever, with a 
temperature of 108 degrees, received 50 grains of antipyrine hypo- 
dermically at 6 p.m., at 7 p.m. he received 10 grains more under the 
skin, at 8 p.m. 20 grains more, and at 9.30 another 20 grains were 
used without effect. In other words, 100 grains in three and a half 
hours proved useless. In children suffering from excessive heat 
during summer weather antipyrine seems to be very useful, and has 
been highly recommended by Demme. It must be used with caution 
lest collapse be induced. 

Asthenic Fevers. 

(Typhoid Fever and Fevers of a Typhoid Type.) 

In the opinion of the author, antipyretics should play a secondary 
role in the reduction of the pyrexia of the typhoid state, our main 
reliance being upon cold applications, the antipyretics being used 
as an adjunct to the cold pack or bath. Aside from the fact that 
he has found such an opinion well founded in a large number of 
typhoid fever cases, logical reasoning endorses its correctness. Even 
if antipyretics were perfectly innocuous, their constant use in fever 
would but give the already over-strained kidneys the task of their 
excretion, while the stomach, sufficiently disturbed by necessary medi- 
cines and illness, has enough to do without the addition of an addi- 
tional load. Further than this, we know that these drugs are not 
perfectly harmless, and we also know that they act on the protoplasm 
of the body, and in consequence must gradually lose their power, 
which is not the case with the cold pack. The writer is sure that in 
typhoid and other low fevers of the continued type antipyretics should 
be given only when the cold pack cannot be used, or at the end of the 
cold application to prevent the temperature from bounding upward 
after its depression. (For Brand's treatment, see Typhoid Fever.) 
Further than this, fever will sometimes resist all doses of antipyretics 
we can give, or all that it is safe to give, but no fever can resist the 
cold bath. In diseases of a more chronic type, particularly those 
represented by phthisis, antipyretics are of doubtful value, owing to 



GASTRALGIA. 481 

the increased sweating which is so apt to be produced, and unless the 
patient seems to be particularly robust they should not be employed 
except in the smallest available doses. 



FRECKLES AND CHLOASMA. 

The removal of freckles is readily accomplished, but their return is 
inevitable if any exposure to the sun or wind occurs. One of the best 
applications for their removal is a solution in water of corrosive sub- 
limate varying in strength from 1 to 4 grains to the ounce, and applied 
night and morning until the skin shows that it is irritated, when the 
lotion must be stopped for some days, after which its use may be 
begun again. A very efficient, and much less dangerous remedy to 
leave about the room in which children are allowed to play, is a satu- 
rated solution of boric acid in water, applied in the same manner as 
is the solution of bichloride of mercury. 

Another remedy is lactic acid, 10 grains to a drachm of water, 
used in the same manner as the solution of the bichloride of mercury. 
The following prescription is recommended by Unna : 

E. — Bismuth oxidi \ 

Pulv. amyli J ° 

Kaolini . 3j. 

Glycerini . . . . . . . f.^ij. 

Aquae rosae q. s. ad f^ij. M. 

S. — Paint on spots and allow to dry, washing the drug off before each new 
application. 

Or the following may be used : 



M. 



GASTRALGIA. 1 

The treatment of gastralgia may be divided into two parts — that 
directed to the relief of the attack when it is present, and that de- 
voted to the prevention of other attacks. During the acute stage hot 
applications and drinks, aromatic and locally stimulating warm in- 
fusions, a few drops of chloroform, or brandy, or whiskey hot and 
concentrated, or 30 or 40 drops of laudanum may be used. Counter- 
irritation often does good, and in some cases, particularly if a suspicion 
of an hysterical element exists, a vigorous revulsive may act with 
surprising success. Emesis and purgation are sometimes indicated, 

1 See article written by author in Keating' s Cyclopaedia of Diseases of Children, 
vol. iii. 

31 



B. — Zinci oxidi 


. gr. iij. 


Hydrarg. ammoniati 


. gr.jss. 


01. theobromae 


. fsijss. 


01. ricini 


. f^ijss. 


Essent. rosae . 


. gtt. X. 


Apply night and morning. 





482 DISEASES. 

since in the early attacks the cause of the pain may be suspected to be 
the presence of indigestible food. 

The treatment required in the intervals between the attacks must 
vary with the cause and with the general condition of health. A care- 
ful search must be made for the real cause of the trouble, and when 
found it must be removed or palliated by appropriate measures. 

The diet should be carefully regulated, and all the hygienic details 
of the patient's life be critically studied and directed. The avoidance 
of improper food, the abandonment of tea, coffee, and tobacco, the 
prescription of proper dress, exercise, or change of residence, may be 
followed by marked improvement in general health and by a cessa- 
tion of the attacks of gastralgia. 

In regard to remedies, it may be premised that all depressing 
drugs must be avoided, as well as all purgatives which would weaken 
the digestion. Any marked disturbance of digestion should be cor- 
rected ; and this may require the use of pepsin, or of some tonic 
remedies such as are suggested in the article on Indigestion. The 
chief reliance is, however, to be placed upon the administration of 
arsenic and iron immediately after meals, in proper form and doses. 
Thus, we may direct : 

E. — Liquor, potassii arsenitis . . . . f £j. 

Vim ferri amari . . . . q. s. ad f^iv. M. 
S. — From 30 to 60 minims in water after meals, three times daily, for a child of 
six years, or twice this quantity for an adult. 

Or, 

E. — Tincturse ferri chloridi f jf j. 

Acidi hydrochlorici diluti 1 - - r. z at 

T . -j- • - ?■ . . . aa t ?ss. M. 

Liquor, acidi arseniosi J ° 

S. — From 4 to 20 drops in water after meals, three times daily. 

Occasionally even better results are secured by the use of cod-liver 
oil in emulsion with hypophosphites. 

The new preparation of bromide of stroutium is a valuable one in 
gastralgia in the dose of 20 grains three times a day. 

It is well, in cases where the pain is very severe, to combine with 
the above a powder of bismuth subnitrate and saccharated pepsin, 
given about an hour or an hour and a half after meals. Consti- 
pation, should it exist, must be overcome by proper diet, massage, 
enemata, or by suppositories of gluten or glycerin or soap. If the use 
of bismuth favors the continuance of constipation too decidedly, small 
doses of cyanide of potassium, dilute hydrocyanic acid, or chloroform 
may be substituted at the same hours. In cases where a highly neu- 
rotic state exists, it may be necessary to alternate all other treatment 
with the bromides or with the preparations of valerian, or the follow- 
ing prescription may be used : 

E. — Acid, hydrocyanic, dil f ^j. 

Ext. cannab. indicse f gj. 

Tr. hyoscyam f 3J. 

Spt. chloroformi f 31J. M. 

S. — 30 minims t. d. in water. 



483 



GASTRIC CATARRH, ACUTE. 

By far the most important point in the treatment of acute gastric 
catarrh is the regulation of the diet, and the following abstract from 
the article written by the author for the third volume of Keating's 
Cyclopaedia of Diseases of Children, embodies the ideas which the 
writer desires to express, so thoroughly, that he has inserted it here. 
The dietetics may be divided into two parts — first, the regulation of 
the food during convalescence or during the attack, and second, the 
character of the food to be used during the interval following one 
attack and preceding the next. Total abstinence from food in the 
acute stages of the attack, and absolute bodily and mental quietude, 
are advisable. There are several reasons for this. In the first place, 
the juices of the stomach are in an abnormal state and unfit to act 
properly if the stomach receive more food. Secondly, the mucous 
membrane of the stomach is already hypersemic from the inflamma- 
tion, and, as the normal viscus becomes physiologically hypersemic 
on the ingestion of food, we would add to the congestion of the blood- 
vessels did we allow more nourishment to enter the viscus. Last of 
all, the excess of the mucus and lactic and butyric acids present ren- 
ders any new food impure before it can be assimilated, and so prolongs 
the trouble. As the attack passes off, small amounts of food may be 
given, which should be readily digested and not likely to become easily 
decomposed or rendered acrid by the mucus in the stomach. Milk with 
a large percentage of lime-water is to be used, since the alkali not only 
prevents a too firm coagulation, but also decreases the secretion and acid 
reaction of the mucus. The thirst is often excessive, although an- 
orexia is complete, and small pieces of ice may be administered for its 
relief. Commonly it will be found that the patient rapidly improves 
up to a certain point, then stops improving, or relapses. This is 
sometimes due to an accumulation of mucus, which when mixed 
with food undergoes fermentation If marked evidences of the 
presence of this secretion are given, a mild and gently acting emetic 
may be employed to dislodge the fermenting mass. In other instances 
the relapses depend upon a tendency to a condition of atony whick 
can only be overcome by prolonged and careful treatment adapted to 
the improvement of the general health. Sodium bicarbonate with 
compound infusion or compound tincture of gentian may be used 
during convalescence, and small sips of effervescing draughts are 
useful. If constipation exists and vomiting forbids the use of the 
ordinary purgatives, a Seidlitz powder divided into fourths or fifths 
and taken in this way every fifteen minutes or half-hour will settle 
the stomach, move the bowels, and often carry away mucus. 

If there is much epigastric distress, a spice poultice is often of 
service. 

Sweets and starches are to be rigidly denied the patient. If anaemia 
exists, iron may be used ; but this is rarely needed. 



484 DISEASES. 

The abdomen should be carefully protected with flannel, and 
draughts and unsanitary surroundings avoided. 

The use of pepsin and of hydrochloric acid is to be much more 
thoroughly attended to than has heretofore been the custom. As a 
rule, we are apt to forget that pepsin acts largely by catalysis, and 
that it is not secreted as pepsin, but as pepsinogen, a substance which 
is changed into pepsin in the presence of an acid. For this reason 
hydrochloric acid should be freely employed, and pepsin given in large 
or small quantity according as there is reason to believe this ferment 
to be in normal or abnormal amount. Common salt (sodium chloride) 
is virtually identical in its ultimate influence with hydrochloric acid, 
and should be always used, in moderation, with the food. 



GASTRIO CATARRH, CHRONIC. 

Chronic gastric catarrh is a condition of the stomach commonly seen 
in this country in a more or less active form. It is often associated 
with much indigestion and the eructation of sour liquids, or even with 
active vomiting. The secretions of the stomach are nearly always 
abnormal, and fermentative changes are constantly present in the 
gastric contents. 

By far the best treatment for this condition is the use of counter- 
irritation over the epigastrium, the close regulation of the diet and the 
use, internally, of nitrate of silver and extract of hyoscyamus, or, if 
any hyperacidity exists, the administration of the subnitrate of bis- 
muth. Constipation is nearly always present, and should be removed 
by appropriate drugs, such as cascara sagrada, of which the best 
preparation is the fluid extract rendered free from bitter taste by certain 
large manufacturers in this country, or in the form of cascara sagrada 
cordial. 

All fats, rich foods, strong meats, ham, bacon, or fried things are to 
be avoided, and only light broths, koumyss, or matzoon resorted to if 
the case be an obstinate or severe one. A nitrate of silver pill should 
be used half an hour before each meal, and be prescribed as follows : 

R . — Argenti nitratis . . . . . . gr. iv. 

Extract, hyoscyami . . gr. x. M. 

Ft. in pil. no. xx. S. — One, half to one hour before each meal. 



GASTRIC DILATATION. 1 

The treatment of dilatation of the stomach may be divided into two 
varieties — the first consisting of the methods of cure which are directed 
against the diseased state of the gastric walls themselves ; the second, 
of those methods by which abnormal changes in the food and the gastric 
contents and secretions are combated, thereby allowing reparative 

1 See article by author in Keating's Cyclopaedia of Diseases of Children, vol. iii. 



GASTRIC DILATATION. 485 

changes to take place. As is well known, dilatation of the stomach 
may be dependent upon some constitutional or some local cause. If the 
cause be rickets, it is evident that the malnutrition of the bony system 
and of the system in general is to be improved, and that remedies de- 
voted to this object are to be given, such as cod-liver oil by inunctions, 
or, if the digestive apparatus will bear it, the oil may be given by the 
stomach. Lacto-phosphate of lime, phosphate of sodium, or iron, 
often in the form of the syrup of the iodide, should be used if any 
sigus of struma are present. Good foods possessing large amounts of 
salts, yet easy of digestion, are, under these circumstances, particularly 
desirable, and by far the larger part of the treatment should be 
directed to the dietetics of the case. Of this the writer will speak 
further on. 

There are several meaus to be employed for the relief of gastric 
dilatation other than those which can be called medicinal, so far as 
drugs are concerned. 

These consist, first, in efforts to evacuate the stomach and to cleanse 
it; secondly, in attempts by these and other means to prevent its 
distention by the gases which arise or by the accumulation of ingesta 
which takes place ; thirdly, in the regulation of the diet so as to avoid 
causes which have a tendency to increase the disorder. 

Dilatation of the stomach is so difficult to cure that very satis- 
factory results are not to be looked forward to ; nevertheless, the 
nutrition and the general state of health are to be carefully consid- 
ered. 

Taking up seriatim the non-medicinal means which we have named, 
we come at once to the consideration of lavage, a method which has 
been resorted to with most thorough trial on the continent of Europe. 
Originally proposed by Epotius in 1863, it has been most widely 
employed in children by Epstein, who in one article alone records its 
employment in two hundred and eighty-six cases of gastric disease in 
infancy, the patients being less than one year of age. 

Epstein employs a No. 8 or a No. 10 Nelaton catheter for the tube, 
and warm water holding in solution a little benzoate of magnesium, 
the latter being resorted to chiefly when fermentation and decomposi- 
tion products are present. If none of these conditions are present, 
ordinary water will usually suffice. The liquid employed should 
always be warmed. Others — as, for example, Lorez — use the ordi- 
nary catheter, of the size known as No. 13 or No. 15. The question 
as to the variety of tube to be employed is a vital one, since a poorly- 
devised apparatus not only gives no relief, but disgusts both the 
patient and the physician with the technique of the method. The 
tube should be more like a hollow bougie than a catheter, in order 
that its calibre may be great enough to carry off some of the semi- 
solid materials present. If this rule is not carried out, two evil re- 
sults follow. In the first place, the tube and its apertures rapidly, 
or even at once, become clogged ; secondly, the liquid is drained 
away, leaving behind a mass which is semi-solid, to be sure, and less 
bulky, but which is, nevertheless, the quintessence of the nastiness of 



486 DISEASES. 

fermentation, and quite as well qualified to leaven any fresh food on 
its entrance as the liquid would be. 

The holes in the gastric end of the tube should, therefore, be large 
enough to take in fairly large masses. In some cases the ordinary 
siphon may be used, but where there is any solid food or resistance, 
suction by means of a stomach-pump is necessary. 

The tube should be twenty-four or thirty inches in length for a child, 
or forty inches for an adult. The methods by which lavage is employed, 
further than those we have named, are as follows : The catheter or tube 
should be passed backward against the roof of the mouth, so that by 
following the curve of the hard and soft palates it is directed into the 
pharynx and oesophagus, and then by gentle pressure forced on down 
into the stomach. As it is introduced the patient should be told 
to swallow. The irritability of the pharynx rapidly disappears 
with repeated operations, and it is surprising how quickly the patient 
becomes accustomed to the operation, and submits to it without any 
feeling of discomfort. After the tube has reached the stomach, a 
small funnel is to be fitted in its external end, which is then held 
above the head of the patient while water prepared in the way we 
have mentioned is poured into it until the stomach is filled, when the 
funnel end is lowered and the stomach is emptied by siphonage. 

The stomach-pump has one very serious disadvantage, which is 
present with even more force in the case of a child than in the adult, 
namely, the danger of injury to the coats of the organ. This appa- 
ratus is also more costly and cumbersome, aud for children the siphon 
is powerful enough in its action to take away all excuse for the use of 
the more complicated apparatus unless the contents of the stomach are 
in bulk. 

It is particularly necessary in children, on account of the lack of in- 
telligent aid and their liability to gulp, that every care should be taken 
that the tube does not slip entirely out of reach into the stomach, and 
for the prevention of this danger a string should be attached to the 
external end of the tube before it is introduced. 

The treatment of dilatation, to be next considered, is dietetic. 
There can be no doubt that one of the chief reasons for the emaciation 
which comes on is the failure on the part of the stomach to digest aud 
assimilate nourishment. In addition to this, the intestine is really the 
place for absorption of food to take place, and the delay of the food in 
the stomach virtually makes the chyme unfit for the function of the 
small intestine. 

The foods to be given are, of course, to be in the highest degree 
capable of ready assimilation, and should be confined, especially in 
severe cases, to the materials which can be readily predigested by the 
employment of the digestive ferments now so largely sold. Carefully- 
skimmed milk is valuable, aside from its inherent usefulness, in that 
it lacks the fats which can be utilized only in the intestines, and which 
simply break down and decompose if kept in the stomach. Oyster 
broth, carefully freed from any oily matters in cooking, and thoroughly 



GASTRIC ULCER. 487 

pancreatized, is to be given. Ordinary whey obtained from milk by 
means of rennet is useful. 

Rectal alimentation to some degree is always useful, and Ewald, of 
Berlin, suggests the following nutrient enema : Beat up two eggs with 
a tablespoonful of cold water ; to this add a little starch, boiled in half 
a cupful of a 20 per cent, solution of grape-sugar and a wineglassful 
of red wine. The solution is to be well mixed at a temperature not 
high enough to coagulate the albumin, and injected as high up into the 
bowel as possible. For a child this mixture should be somewhat less 
in quantity than that given for the adult, particularly as to the wine. 

An exceedingly important part of the dietetic treatment of gastric 
dilatation consists in the constant bearing in mind of the fact that the 
tendency of food is to accumulate, and the avoidance of the pernicious 
habit of adding solids or liquids to the quantity of ingesta still re- 
maining from a previous meal. If the child is old enough, all the 
remains of previous feedings should be removed by lavage before 
anything more is given, since otherwise the sweet food is at once con- 
taminated by the liquids which it meets in the stomach. 

The medicinal treatment of gastric ectasy is, unfortunately, very 
limited, so far as the stomach itself is concerned, and, indeed, we doubt 
whether any direct medication can ever be of much value unless in 
the form of disinfectant substances, such as we have spoken of when 
speaking of lavage, and these only prevent decomposition of the food 
and do not effect a cure. 

In a case of marked gastric dilatation we should, nevertheless, al- 
ways resort to the bitter tonics, such as gentian or calumba, and for 
the improvement of the muscular coats of the viscus should employ 
the tincture or extract of physostigma in the dose of 5 to 10 drops or 
J- to J grain, respectively. In the case of a child under the author's 
care a very extraordinary improvement followed the use of this drug 
and the careful fulfilling of all the directions just given except the 
lavage, which was not employed. 



GASTRIC ULOER. 

In the treatment of gastric ulcer three points must be borne in mind 
as being essential. These are, rest for the stomach as far as possible, 
rest for the patient herself, and the maintenance of the general health. 
The first of these points involves a consideration of diet. If, in any 
case, the stomach is very irritable it is best to place the patient in bed 
and nourish her for from two to eight days by means of enemata. 
Probably the best form of nourishment for this purpose is a mixture 
recommended by Dreschfeld and consisting of 2 raw eggs with 2 
ounces of beef-tea and a little brandy, which may amount to 1 ounce 
if the patient really needs stimulants. It may be well to place a little 
pepsin in this injection to peptonize the proteids, but if this is done 
the alcohol must be left out, as it will interfere with the activity of the 
pepsin. Pancreatin may also be used with advantage in some cases in 



488 DISEASES. 

the amount of 5 or 10 grains in each injection. For the relief of 
thirst, which may be excessive if rectal alimentation is resorted to, the 
patient should hold in the mouth small pieces of ice or drink moderate 
quantities of barley or rice water. After this treatment has been used 
for some days small quantities of food may be given by the mouth, 
such as a little peptonized milk or a little warm milk with lime-water 
in the proportion of half and half, or 1 part lime-water to 2 of milk. 
After this thin arrow-root or gruel may be given in moderate quantity. 
It is better to give the food in small amount every two hours than in 
larger quantity three times a day. The increase in rations, both as to 
variety and amount, should be most gradual, the physician extending 
the dieting over at least six weeks, of which the first two had best be 
spent in bed. It is well to use massage and electricity under these 
circumstances to preserve nutrition, as in the rest cure. (See Rest 
Cure.) Beef-tea and soups had better be avoided during the early 
stages of the treatment, as they will irritate the stomach. Soft-boiled 
eggs, tender chicken or game, and minced lamb may be finally given. 
Cheese, coffee, tea, beer, and ale are to be avoided, as are all hot 
drinks. Fresh green vegetables may be used in moderation, but fresh 
bread and unripe fruit must be carefully avoided. When milk is 
taken it should be warmed The presence of gastric pain indicates 
that the diet must be cut down in quantity or the nutrition carried on 
by rectal injection. 

The drug treatment of these cases is both palliative as to pain and 
curative. For the pain counter-irritation of a more or less severe and 
constant type should be applied to the epigastrium, either as a spice 
or mustard plaster or by means of a hot-water bag. The counter- 
irritation should be as continuous as possible. Sodium bicarbonate 
and the subnitrate and subcarbonate of bismuth are also of service in 
the dose of 20 grains each, and to these may be added from -^ to \ of a 
grain of morphine hydrochlorate or 1 grain of codeine. These may be 
given thrice daily if necessary. Only the smallest dose of morphine 
necessary to relieve the pain should be employed. By far the best 
treatment for the pain and for the ulcer itself is the following pill : 

r* . — Argenti nitratis gr. iv. 

Extracti hyoscyami . . . . gr. x vel xx. M. 
Ft. in pil. no. xx. S. — One pill half to one hour before meals. 

For the constipation which is frequently present the patient may 
receive a dose of Carlsbad salts or phosphate of sodium, or even the 
sulphate of magnesium. 

For the relief of vomiting and of hsematemesis absolute abstinence 
from food, so far as its administration by the mouth is concerned, is 
to be insisted upon. Nutrition must be maintained under such cir- 
cumstances by the rectum. Small doses of J grain of cocaine may be 
given, or cocaine and bismuth subnitrate together if the vomiting is 
persistent. Sometimes drop doses of creasote are useful, or carbolic 
acid may be given in the same dose with 20 grains of subnitrate of 
bismuth. One of the best remedies for haematemesis is oil of turpen- 



GASTRO-ENTERITIS. 489 

tine in the dose of 5 to 10 drops four times a day. In other cases 
good results will often follow the use of the solution of the sub- 
sulphate of iron (Monsel's solution) in the dose of 3 drops every 
half-hour or by the employment of 3 grains of the salt itself in pill. 
Cold compresses or an ice-bag should be applied to the epigastrium. 

Should perforation of the stomach occur the prognosis is most 
gloomy. The tendency to peritonitis should be antagonized by the 
application of cold to the belly Avail, by the avoidance of food, perfect 
physical rest, and supportive treatment in the way of heat to the limbs 
and the hypodermic use of ether, brandy, or ammonia. Morphine 
should also be pushed actively unless collapse is too pronounced, as it 
tends to prevent abdominal pain and inflammation. Operative meas- 
ures are to be resorted to in suitable cases. 



GASTRITIS, ACUTE. 

This is generally due to the ingestion of irritant foods or drinks, 
rarely arising in its true acute form from other causes. 

The treatment is to be directed entirely to the prevention of the 
spread of the inflammation and to the relief of that already developed. 
If the patient is seen soon after the onset of the trouble, the stomach is 
to be emptied of all irritant substances by means of vomiting induced 
by large draughts of warm water, or, better still, by the use of the 
stomach-pump, as the retching may increase the irritation. Muci- 
laginous drinks are to be given freely, and albuminous materials seem 
especially useful. Oils and similar protective liquids aid in prevent- 
ing further damage. Opium, to allay pain and the local and systemic 
irritation, is invaluable. This drug should always be given in liquid 
form, and the deodorized tincture is the best in this respect, owing to 
its freedom from narcotiue. Paregoric contains too little opium to be 
of value, and is irritating because of its volatile oil. If the stomach 
will not retaiu drugs, they should be given by the rectum. If evi- 
dences of collapse appear, hot applications, atropine, or belladonna 
should be exhibited. It is important that the heat should be applied 
over the epigastrium and chest, and a flaxseed poultice is the best 
method of doing this. Practically the same rules hold good in regard 
to diet in both acute gastritis and in gastro-enteritis. 



GASTRO-ENTERITIS. 

Gastro-enteritis is a condition of inflammation affecting the entire 
alimentary canal in some instances, and commonly produced by the 
ingestion of some irritant substance, either in the form of bad food, 
poisons, or mechanical irritants, such as grape-seeds or cherry-stones. 
The symptoms accompanying it are exceedingly various, but consist 
chiefly in pain of a griping character with watery or mucous stools, or 
if the inflammation be very severe, absolute and unyielding constipa- 



490 DISEASES. 

tion may be present. The nervous symptoms depend upon the degree 
of irritation and the general nervous tendency of the patient, and if 
the trouble is very severe, he may go on into a condition of shock or 
collapse. 

If the irritation is very intense exfoliation of the mucous membrane 
may take place, the epithelium coming away in shreds. 

The treatment of gastro- enteritis depends upon its severity and 
oause. Almost always we first allay the pain and tendency to inflam- 
mation by the hypodermic use of morphine, and immediately follow 
this or precede it by an emetic of a non-irritating and rapidly acting 
type, such as apomorphiue, provided there is reason to believe that the 
poison or food still remains in whole or in part in the stomach. If 
the irritant has been taken some time before the physician is called in 
to see the case, emetics are contra-indicated, as by disturbing the 
abdominal contents, they render the inflammation worse. Following 
this, or in place of it if emetics are not useful because the poison has 
already passed through the pylorus, castor oil in the dose of 2 to 3 
tables poo nfuls to an adult may be given to sweep out the offending 
materials and lubricate the intestinal walls. In other cases sulphate 
of magnesium may be used, but not sulphate of sodium or Rochelle 
salt, as they are both irritant. The sulphate of magnesium is of value 
because in addition to its purgative effect it also depletes the inflamed 
bowel. Having gotten rid of all offending materials opium and 
sulphuric acid are to be freely used to allay irritation and control 
diarrhoea (see Diarrhoea), and hot compresses are to be applied to the 
belly, or a spice or mustard plaster used instead. Vomiting when it 
is excessive is to be treated in the manner described under that head. 
The after-treatment of acute gastro-enteritis is very important both in 
respect to food and drugs. The inflammatory process, if severe, will 
have interfered with or destroyed glandular action to such an extent 
that starvation from the non-assimilation of food may occur. Pre- 
digested foods are therefore in many cases indispensable, and a care- 
fully regulated diet a sine qua non. 



GLAUCOMA. 

Glaucoma, or that disease dependent upon an increase of intra- 
ocular pressure, appears in an acute or chronic form. The disease in 
general terms is characterized by halos appearing about the gas-light ; 
periods of obscuration of sight ; shrinking of the nasal half of the 
field of vision ; narrowing of the anterior chamber of the eye ; anaes- 
thesia of the cornea; and increased tension of the eyeball. In the 
" glaucomatous attack," or acute glaucoma, the injection of the eye- 
ball is intense ; the lids swell, there is photophobia, the cornea is 
steamy, the pupil dilated and motionless, and the vision rapidly de- 
stroyed. The case may be mistaken for iritis or acute ophthalmia — 
a fatal blunder. 

Iridectomy or an equivalent measure is the only treatment for 



GONORRHCEA. 491 

glaucoma. If for any reason this is delayed, a solution of the 
sulphate of eserine, 1 to 2 grains to the ounce, or pilocarpine nitrate 
in twice this strength, should be dropped into the eye every two or 
three hours until relief follows. Atropine must not be employed. Hot 
compresses, opiates, and leeches are also useful to alleviate the pain, 
if for any reason operation is delayed. 



GONORRHOEA. 

The therapeutics of urethritis varies in accordance with whether 
the disease is acute or chronic, and is very greatly modified by the 
seat of inflammation — a posterior urethritis, for anatomical and 
mechanical reasons, not being amenable to the same treatment which 
will prove successful when the disease invades the penile portion of 
the urethra. 

The membranous and prostatic portions of the urethra constitute 
its posterior part. They are surrounded by layers of powerful muscles 
which keep the canal constantly occluded, and which play the part of 
vesical sphincters. Hence, any injection forced into the urethra passes 
to but not beyond its membranous part, and is worse than useless if 
administered with the intention of combating inflammation of the 
posterior urethra. 

Since the general acceptance of the gonococcus as a specific cause of 
gonorrhoea the treatment of acute anterior urethritis has been mainly 
antiseptic, those drugs being chosen which are found to act most 
powerfully upon the specific germs and at the same time produce the 
least irritant action upon the mucous membrane. Bichloride of 
mercury, as representing the most powerful germicide known to 
medicine, has been used most extensively. The main objection to its 
action lies in the fact that when employed in efficient strength it is 
exceedingly irritating. This effect may, to some extent, be avoided by 
using a large quantity in dilute solution, and one of the most satis- 
factory treatments yet advocated consists in thoroughly and repeatedly 
flushing the urethra with bichloride lotion 1 to 20,000 or 1 to 40,000. 
This may be accomplished by means of a bulbous catheter provided 
with numerous small apertures opening backward just behind the 
enlarged extremity ; immediately after urination the bulb is carried to 
the membranous portion of the urethra, the tube from an irrigator is 
then attached to the extremity of the catheter, and one or two pints of 
dilute mercury solution, as hot as can be borne, are injected. This 
may be repeated once or twice daily. When the urethra is so sensitive 
that the passage of an instrument is not practicable, a conical nozzle 
carrying a supply- and a drainage-pipe, and of a size to close the 
meatus entirely when inserted, may be employed for irrigation. The 
drainage-pipe should be of slightly smaller calibre than that which 
carries the solution into the urethra. This insures the passage of the 
injection back as far as the membranous portion of the urethra, beyond 
which it will not pass if the pressure does not exceed that obtained 



492 DISEASES. 

by elevating the irrigator two feet above the level of the urethra. 
When neither of these methods of irrigation can be practised, a syringe 
with a conical nozzle and with a capacity of at least one ounce may 
be employed; this should be used six or eight times a day, two syringe- 
fuls of the dilute lotion being injected immediately after urination. 
The liquid should be forced in very gently, being allowed to flow out 
by slightly lessening the pressure of the nozzle upon the meatus when 
the anterior urethra is full. When large injections are attempted by 
the ordinary small urethral syringe, the frequent application of the 
latter to the meatus occasions much irritation. As a precaution against 
forcing the injection into the posterior urethra the patient may be in- 
structed to sit with the weight of the body bearing upon a folded towel 
placed beneath the perineum. These copious irrigations inaugurated 
in the earliest stage of gonorrhoea are frequently successful in pro- 
ducing a complete cure in a few days. 

Much stronger solutions of mercury are frequently employed, the 
concentration depending upon the subjective sensations of the patient 
and varying from 1 to 1000 to 1 to 4000. 

The addition of other antiseptic agents to the mercury solution 
has been found advantageous. A favorite injection of Dr. J. William 
White is : 

&. — Hydrarg. chlor. corros gr. ij vel iv. 

Zinci sulpho-carbolat gr. ij vel x. 

Acid, boric . . . . . • 3J- 

Hydrogen, peroxid. . . . . . f 3j. 

Aquae . . . . . . q. s. ad f^viij. M. 

The strength of this should be varied to suit the individual. 

While this prescription is an incompatibility, Dr. White states that 
the results obtained are exceedingly good. 

Any of these ingredients may be used alone or in combination. 
Either individually or together, they probably represent the most 
efficient topical medication yet discovered. When the gonorrhoea has 
already assumed a markedly inflammatory type, with swelling and 
oedema of the penis, redness and eversion of the meatus, and great 
sensitiveness of the urethra, no injection should be employed. The 
penis should be wrapped in cloths kept wet with alcohol and water, 
or lead-water and laudanum. With the subsidence of acute inflam- 
matory symptoms and the appearance of copious discharge, the injec- 
tion treatment may be inaugurated. It must be remembered that 
injections may in themselves prevent the discharge from entirely dis- 
appearing. Hence, as the symptoms ameliorate, the injection should 
be made less frequently; finally being entirely omitted for some days 
if the discharge seems to continue longer than usual. 

Internal medication and constitutional treatment are most impor- 
tant in all forms and stages of gonorrhoea. It is almost universally 
accepted that certain drugs, such as copaiba, cubebs, and oil of san- 
dalwood, when eliminated through the kidneys, possess the power of 
inhibiting the growth of the gonococci or of destroying their vitality. 
Bacteriological research has shown that of this class of remedies 



GONORRHCBA. 493 

copaiba alone possesses such power. To this drug must be added 
salol, which has been proved by laboratory and clinical tests to exert 
a powerful germicidal action upon the gonococcus. Cubebs is useful 
not because it has any specific action, but because it exerts a dis- 
tinctly modifying action upon the ardor urince, one of the most 
distressing symptoms of urethritis. A very admirable formula sug- 
gested by White is as follows : 

R . — Salol . gr. v vel x. 

Oleoresinse cubebse . . . . . gr. v. 
Copaibse (Para) . . . . . . gr. x. 

Pepsinse gr. j. M. 

Ft. in capsul. j. S. — Take one of these capsules six times daily. 

Beyond the capsules there is little need of medication by the 
stomach. Obstinate chordee may require bromide of potassium and 
chloral. Of these a drachm of the former must be given at bed-time, 
and 10 grains of the latter, which may be repeated in the night if 
painful erections persist. Lupulin in 30-grain doses is also indorsed. 
When practicable, opium or belladonna suppositories, or hypodermic 
injections into or about the perineum of morphine gr. J and atropine 
gr. q!q- will prove very satisfactory. In all cases the patient should be 
instructed to rise once during the night and pass his water. 

Ardor urince is usually relieved by the use of cubebs, as in the 
capsule given above, by demulcent drinks, and by the employment of 
bicarbonate of sodium or citrate of potassium in sufficient doses to 
render the urine slightly alkaline. Either of these drugs is conve- 
niently administered in the form of compressed tablets taken one or 
two hours after meals in 10-grain doses, the quantity being increased, 
if necessary, until the desired effect is produced on the urine. The 
instillation into the urethra, by means of an eye-dropper, of a 4 per 
cent, solution of cocaine a few minutes before urination markedly 
diminishes the burning. Finally, this symptom may often be relieved 
by instructing the patient to pass his water with the penis submerged 
in a vessel containing water as hot as can be borne. 

Where the inflammation is of a high grade and attended by fever 
and general malaise, the administration of 2 drops of aconite repeated 
every two or three hours is followed by marked relief. 

In regard to the general treatment of a patient suffering from 
gonorrhoeal urethritis, rest in bed is particularly desirable. This, 
however, is rarely possible, and the surgeon must be content with 
enforcing the avoidance of all active exertion and the observance of 
as much rest of mind and body as is compatible with a continuance 
of the daily routine of business life. While skimmed milk or butter- 
milk diet is theoretically desirable, the advantages to be gained by 
it are scarcely sufficient to justify insistance upon such a regimen, 
especially as it would excite suspicion as to the presence of venereal 
disease; hence a light diet consisting mainly of vegetables and fruits, 
and in quantity about half that usually taken, with a minimum 
amount of meat, should be advised. In addition the patient should 
be induced to drink liberally of plain water or any of the sparkling 



494 DISEASES. 

mineral waters, as by this means the nrine is not only, rendered bland 
but greatly increased in quantity, thus enabling the urethra to be 
fully flushed from behind many times a day. Flooding of the stomach 
with such large quantities of liquids as to produce dyspepsia is to be 
carefully avoided. It is scarcely necessary to state that copulation or 
any form of venereal excitement must be strictly interdicted. Finally, 
prolonged warm baths lasting from half an hour to two hours seem 
to exert a favorable influence upon the local inflammation. 

Acute posterior urethritis does not usually develop until the dis- 
ease of the penile portion of the urethra has run a course of two or 
three weeks. During the very acute symptoms local treatment 
applied to any portion of the urethral canal probably aggravates the 
condition, and even the internal administration of balsams and anti- 
septics must be employed with very great caution, their use being 
suspended at once if the inflammation seems to be aggravated by their 
employment. Hence, when in the third week of gonorrhoea there is a 
violent outbreak of inflammation in the membranous and prostatic 
portions of the urethra, suspension of all active treatment is indicated. 
The bowels are kept open, the diet is carefully regulated, the urine is 
rendered bland, unirritating and antiseptic, continued warm baths are 
ordered, the painful symptoms being controlled by opium and bella- 
donna administered either hypodermically or in the form of a supposi- 
tory. When the acute symptoms subside, the quantity of antiseptics 
taken by the mouth may be increased, balsams may be added, and 
local treatment may be directed, first to the posterior urethra, after 
the cure of which the anterior urethritis should receive attention. It 
has been stated already that injections forced into the meatus rarely 
penetrate beyond the bulbous portion of the urethra, hence to influ- 
ence the deeper portions of this canal some other method of applying 
these drugs must be devised. This end is best accomplished by means 
of Ultzmann's irrigation catheter, or other instrument similar in 
principle. 

The patient is first instructed to empty the bladder of a portion of 
its contents ; by this means the urethra is flushed out. The catheter 
is then introduced into the membranous portion of the canal, and, by 
means of a syringe, 1 ounce of the injection is forced into the mem- 
branous and prostatic portions of the urethra. This fluid does not 
regurgitate along the sides of the catheter, but enters the bladder, and 
is passed with the urine at the next act of micturition. The injection 
most employed is the following : Nitrate of silver, grain J to 1 ; dis- 
tilled water, §j. Carbolic acid, 1 grain to the ounce, or any of the 
injections used in anterior urethritis, may also be employed. These 
injections should be made twice a week. 

Chronic Gonorrhoea. 

Chronic gonorrhoea differs from the acute form in the fact that the 
inflammation is distinctly localized in certain portions of the urethra, 
and does not invade the whole canal with uniform intensity ; hence, 



GONORKHCEA. 495 

efficient treatment must be directed not to the whole urethra but to 
the diseased areas. Foci of chronic urethritis are usually found 
either in the bulbous portion of the urethra or in the membranous or 
prostatic portions. If the disease is located in the anterior urethra 
it will commonly be found to depend upon the existence of a stricture 
of large calibre. The passage of sounds of full size — cutting the 
meatus if this is necessary for their introduction — will be followed by 
prompt relief in such cases. The sounds should be used not more 
frequently than twice a week, and should be most carefully sterilized 
before introduction. 

If after free dilatation the discharge still persists, and a large por- 
tion of the anterior urethra is in a catarrhal condition, as shown by 
examination of the urine, irrigation of the urethra should be prac- 
tised. This may be best effected by passing a soft rubber catheter 
down to the membranous portion of the urethra, and injecting through 
it once daily 3 ounces of a half-grain-to-the-ounce solution of nitrate 
of silver. When the general catarrhal coudition is materially modi- 
fied, by means of an ordinary hard-rubber endoscope and a head- 
mirror the focus of inflammation may be exposed, and may be treated 
directly by strong astringent solutions carried in by means of a brush 
or by absorbent cotton secured to the extremity of a long applicator. 
Nitrate of silver or sulphate of copper, 20 grains to the ounce, may 
be employed. Unna has devised a most successful treatment for ob- 
stinate cases of gonorrhoea. He advises coating the sounds with the 
following mixture : 

Be. — 01. cocse ^iij. 

Cerse flav. . ....... ^ss. 

Argent nitratis ...... gr. xv. 

Balsam. Peruvian. . . . . . JJss. M. 

This is liquefied in a water-bath, the sounds are clipped in it and 
are then hung up to dry. On being passed, the heat of the body 
melts the coating. The objection to their use lies in the fact that the 
application is made to the entire urethra. Practically, however, their 
employment is often followed by brilliant results. 

Chronic posterior urethritis must be treated by remedies applied 
directly to the diseased area. Nitrate of silver is more commonly 
successful than any other medication. By means of Ultzmann's appa- 
ratus three or four drops of a solution varying in strength from 0.1 
per cent, to 5 per cent, may be employed. 

Finger recommends the following ointment : 

li . — Argent, nitratis vel cupri sulph. . . . gr. xv. 

Lanolin ,^iij. 

01. olivse 3jss. M. 

By means of an ordinary catheter- — which is first filled, then intro- 
duced until its eye reaches the prostatic portion of the urethra — a 
definite quantity of the ointment can be forced into the canal by a 
graduated rod. 

In many cases pressure will exert a curative action, causing prompt 



496 DISEASES. 

absorption of inflammatory effusion. To accomplish this result large 
sounds may be passed into the bladder. Frequently the therapeutic 
influences of cold, together with pressure, are found beneficial. The 
best means of combining these two remedies is found in the psychro- 
phore, an instrument in the shape of a sound, but so arrauged that a 
stream of water flows through its iuterior. 

It must be borne in mind that chronic gonorrhoea is commonly due 
to unskilful or not sufficiently prolonged treatment of the acute stages. 
Not only should the treatment of acute gonorrhoea be continued until 
the gonococci have entirely vanished, but for fully two weeks after 
the disappearance of all symptoms of inflammation. The same rule 
holds good in regard to the chronic manifestations of the disease. 
Only after careful examination of the urine fails to show any sign of 
inflammatory trouble for at least two weeks should the treatment be 
suspended ; and this should not take place suddenly, but the intervals 
between the applications be gradually increased in length, the patient 
being carefully watched in the meantime. 

Per contra, it must not be forgotten that long-continued irritant 
treatment may in itself indefinitely prolong a urethral discharge. 
Hence, it is wise to suspend all injections in certain cases, and to ex- 
amine the discharge carefully, as found in the urine, to determine 
whether or not the continuance of symptoms is dependent upon this 
cause. 

There is a mucous secretion which quite frequently follows gonor- 
rhoea, but which is in no way dependent upon the persistence of this 
disease. Microscopic examination will at once determine its nature. 
It is probably most rapidly cured by attention to general hygiene and 
by tonic and supporting treatment. 

Complications of Gonorrhoea. 

Among the many local and general complications which may occur 
in the course of an acute or subacute gonorrhoea are balanitis, balano- 
posthitis, prostatitis, and epididymitis. 

Balanitis and balano-posthitis are treated by perfect cleanliness. 
The discharge must be thoroughly washed out, and the surface must 
be dried and isolated. The thorough cleansing of the parts is best 
accomplished by weak astringent solutions, such as the chloride of 
zinc, 4 grains to the ounce, 1 per cent, boric acid, or 1.5 per cent, car- 
bolic acid ; nitrate of silver is particularly valuable, and in the pro- 
portion of 1 grain to the ounce will be found sufficiently strong for use 
as a wash or injection. The superficial ulcerations may be further 
touched with the solid stick of the nitrate of silver. The prepuce 
having been retracted and the parts having been thoroughly washed, 
dusting powder, such as tannin or oxide of zinc, is distributed over 
the surface of the inflamed parts ; the glans is then covered with a 
thin layer of absorbent cotton, and the prepuce drawn forward. This 
dressing is to be repeated three times daily. 

If the phimosis is so tight that the prepuce cannot be retracted, 



GONORRHCEA. 497 

cleansing, astringent injections and wrapping the penis in one or two 
thicknesses of gauze or other thin fabric, constantly kept wet with 
dilute lead-water, will be the treatment indicated. If, in spite of this 
treatment, inflammatory symptoms become more marked, circumcision 
is indicated. 

Prostatitis rarely develops before the second or third week in the 
course of urethritis. Where the acute symptoms are fairly developed 
direct local treatment is of little avail. Rest in bed, light diet, careful 
regulation of the bowels, medication to render the urine bland and 
unirritating, elevation of the pelvis, local depletion by means of leeches 
applied to the perineum, and the administration of morphine and bella- 
donna, either by means of suppository or by hypodermic injection, 
represent the general treatment of all inflammatory conditions at or 
about the neck of the bladder. In the great majority of cases, pros- 
tatitis undergoes prompt resolution, and this is more powerfully influ- 
enced by rectal injections than by any other method of treatment. 
For this purpose a two-way rectal tube must be employed, the nozzle 
of which is directed against the projection of the prostate into the 
bowel. From 2 to 4 quarts of water, either very cold or as hot as can 
be borne, are allowed to flow into the rectum by gravity, this arrange- 
ment of the tubes allowing the injection to flow out as rapidly as it 
flows in. This treatment should be repeated three or four times a day. 
When, in spite of careful treatment and the free use of anodynes and 
antispasmodics, there is retention of urine, a soft catheter should be 
passed into the bladder and allowed to remain there. 

If general and local symptoms denote abscess formation, the pus 
should be evacuated by perineal incision as soon as its presence is posi- 
tively determined upon. It is true that the pus collection usually is 
spontaneously discharged into the urethra, but this result cannot cer- 
tainly be depended upon, and, at best, is an unsatisfactory termination 
of the trouble. 

W'hen the inflammation runs into a chronic type, the treatment 
suitable for chronic posterior urethritis is indicated, namely, the use of 
large cold steel sounds and local applications to the prostatic urethra. 
In addition rectal injections, by means of the two-way tube, are very 
efficient in producing a cure. 

Epididymitis requires rest in bed, cessation of all local treatment 
directed against the gonorrhoea, the elevation of the pelvis and testi- 
cles, and the systemic treatment applicable to acute inflammation. 
The general tendency of this complication of gonorrhoea is toward 
spontaneous resolution. The testicles may be supported by a hand- 
kerchief bandage, the base of which is passed beneath the scrotum 
while the ends and apex are secured in front to a circular band passing 
about the waist. To combat the agonizing pain and hasten the cure 
punctures have been advised. These, by relieving tension, promptly 
alleviate the suffering. Ice-bags may also be applied, though it is 
claimed that as a result of this treatment there remains an obstinate 
induration of the epididymis. Local applications of the nitrate of 
silver and of tincture of iodine are also said to act beneficially. 

32 



498 DISEASES. 

Since it is usually impossible for a patient suffering from gonor- 
rheal epididymitis to keep to his bed, a treatment must be devised 
which will allow him to attend to his business, and at the same time 
will prevent the inflammation from becoming aggravated. The part 
must be splinted ; if at the same time uniform pressure can be applied 
the cause of the trouble will be still further favorably modified. These 
indications are complied with, partially at least, by strapping the in- 
jured testicle. For this purpose a number of adhesive resin strips, each 
half an inch wide and long enough to pass three-fourths around the 
swelled testicle, are cut. The first strip encircles the scrotum between 
the affected testicle and the body, tightly imprisoning the former in a 
pouch of skin. The succeeding strips are then placed each overlap- 
ping the other in such a manner that the entire pouch is covered in, 
and a handkerchief bandage, applied as described above, may then be 
used to elevate the testicle. A better means of securing rest and 
pressure, and at the same time exerting the resolvent influences of heat 
and moisture, is offered in the dressing proposed by Horand-Langle- 
bert. The entire scrotum is first enveloped in a thick layer of cotton ; 
over this is placed a piece of rubber-dam sufficiently large to cover-in 
the cotton, and the dressing is completed by an ordinary suspensory, 
gored at the sides and provided with tapes to allow of close fitting. 
Unless there be decided swelling of the spermatic cord this dressing 
usually allows the patient to attend to his business, and is followed by 
as prompt resolution as though confinement to bed had been insisted 
upon. When the acute symptoms have disappeared attention must 
be directed to the removal of infiltration, which if it persists may be 
a cause of sterility. This is accomplished by the continuance of heat, 
moisture, and pressure ; by local applieations, such as iodine gr. iv in 
lanolin 5j, or of equal parts of mercury ointment and belladonna oint- 
ment, or by ichthyol, with lard half and half, and by the internal 
administration of iodide of potassium, 10 to 20 grains three times 
daily. 

Gonorrhoea in the Female. 

The symptoms of acute gonorrhoea in the female are usually so 
mild that the attention of the physician is rarely called to the disease 
until it has reached its chronic form and has invaded the uterus and 
its appendages. When, however, acute urethritis is found, the treat- 
ment, both local and general, is conducted on the same principles as 
when the disease attacks the male urethra. During the most acute 
stage no local treatment is advisable, but subsequently injections can 
be made with the ordinary hard-rubber syringe, not more than a 
drachm and a half of the liquid being employed at a time. If the 
urethral discharge persists, the seats of the suppuration are readily 
found by the endoscope tubes and treated directly by applications of 
strong solutions of nitrate of silver or sulphate of copper. The results 
of treatment are commonly satisfactory. 

Acute vaginitis is not very frequently observed. In addition to 
the general treatment of inflammation, local treatment directed to 



gout. 499 

cleansing thoroughly the inflamed surfaces of discharge and acting 
upon them by a strong antiseptic lotion, will be followed by a rapid 
cure. The patient is instructed to irrigate the vagina three times 
daily with two pints of bichloride of mercury solution, 1 to 4000, 
thrown in by means of a fountain syringe. For this fluid to reach 
every portion of the diseased mucous membrane, it is necessary that 
the patient should lie upon her back with the hips elevated. Before 
rising, a pledget of absorbent cotton is placed between the labia. 
During the most acute stage of vaginitis hot-water injections and pro- 
longed hot sitz-baths are indicated. In addition to the antiseptic 
irrigations which the patient is directed to make, the physician should 
every second day insert a speculum and paint every portion of the 
diseased mucous membrane with nitrate of silver solution, varying in 
strength from 4 to 40 grains to the ounce. The vagina should then 
be packed with tampons of absorbent cotton, which may be dusted 
with astringent medication. 

Vulvitis corresponds to balanitis in the male and is treated in a 
similar manner. Cleanliness is the most essential point in securing a 
cure. The parts are thoroughly washed with weak antiseptic lotions, 
and the abraded mucous surfaces are kept from coming in contact by 
means of a layer of absorbent cotton, or a piece of lint soaked in 
dilute lead-water or other mild astringent solution. 



GOUT. 

Gout is a word used to signify a series of manifestations occurring 
chiefly in those who have led a lazy, sluggish life, and have lived 
on the fat of the land and partaken more frequently of alcoholic 
beverages than of water ; or it occurs in persons who do not live in 
this way, but whose ancestors will be found to have done so, and to 
have handed clown to them the gouty taint or diathesis; or, once 
more, in those who have had poor food for a long time. In other 
words, it is a disorder of nutrition and metabolism. Very few 
Americans have gout in its marked and characteristic forms, owing 
to the active life pursued and to the fact that the inhabitants of the 
Western hemisphere drink large amounts of water, thereby continually 
dissolving effete matters in the system and washing them away. 

The importance of pure water in this state is therapeutically 
remarkable, and the so-called lithia waters depend for their value 
more upon their freedom from salts than their presence. When a 
patient goes to medicinal springs he simply acts as a sluice-way, and 
by continually drinking water washes out the kidneys and prevents 
deposits of calcareous matters throughout the body. In a gouty 
individual the liquids of the body may be said to be so overladen 
with salts that they deposit them wherever a spot is found which is 
easy of access, just as water laden with lime forms a deposit on the 
sides of its bed when a drought comes on, and dissolves and removes 
these formations when a freshet takes place. Very often, when such 



500 DISEASES. 

waters are not attainable, satisfactory results will be reached by ordi- 
nary distilled water, the insipid taste of which can be overcome by 
charging it with carbonic acid gas. 

When an acute attack of gont comes on, it is generally situated, 
as is well known, in the joints of the big toe or other toes, but may 
involve any part of the body, even to the heart aud the contents of 
the abdomen. By far the best remedy for the relief of the pain is 
morphine, which should be given hypodermically, some persons say 
as near the spot involved as possible. At the same time the best 
remedy for s gout that we have, colchieum, should be freely given 
until the patient shows the full effect of the drug, as evidenced by 
gastro- intestinal discomfort or pain and slight laxity of the bowels. 
The drug should be used in the form of the wine of the root, not that 
of the seeds, in the dose of 20 drops at first, and increased by one drop 
every four hours until relief is obtained or symptoms of poisouing 
appear as noted above. In usiug this drug it is important to remem- 
ber that retrocedent gout is more apt to occur under its influence than 
in an attack where the drug is not used. That is to say, the inflam- 
mation in the great toe may suddenly disappear, only to break forth 
in a violent and frequently fatal entero-colitis, gastritis, cerebritis, or 
heart-failure. Any intestinal irritation or diarrhoea predisposes very 
commonly to such a complication under the use of colchieum. 

The local treatment of gout, when it is active, consists in the 
application of a number of much vaunted but frequently useless 
remedies. For hospital practice a very useful mixture is made by 
adding one part of bicarbonate of sodium to nine parts of linseed oil, 
and wrapping the joint involved in a piece of lint soaked with this 
concoction. In other cases collodion may be applied in one or two 
good coats, not more, with relief, and in still others oil of pepper- 
mint has been recommended. It is to be remembered, however, that 
the inflamed joints are not to be treated by depletion through leeches 
or bleeding, as by this means they ultimately become worse ; or, in 
other words, the treatment of gouty inflamed joints is not identical 
with that of inflamed joints from other causes. When the pains of 
acute gout are very severe at night, potassium iodide, in the dose of 
15 grains at four or five o'clock in the afternoon, will sometimes 
give relief; this drug should always be combined with colchieum if 
the disease is subacute or chronic. 

In chronic gout, except during the acute exacerbations of the dis- 
ease, colchieum is almost useless, but potassium iodide should be 
pushed to the point of iodism, if the trouble be painful. Here diet 
comes in for a great part of the treatment, and should consist of 
foods which are not fatty nor rich, but plain and nourishing. Milk 
and eggs, the white meat of chicken, and fruits cooked without sugar 
being added, are allowed, tea and coffee being used only in modera- 
tion. If any wine is taken, it must be followed by copious draughts 
of pure water, and this last article should be used ad libitum. On 
the other hand, pastries, and, more than all, sweet wines, are the 



HAEMORRHAGE. 501 

worst things that such a patient can take, and must be absolutely 
prohibited. 

The insomnia of chronic or subacute gout is best put aside by potas- 
sium bromide and chloral, the former drug being the safest and best. 

The local treatment of chronic gout consists in the application of 
flying blisters at a little distance from the suffering joint every few 
days. Where the deposit around the joints is very great and the 
normal movements are impossible, relief is often obtained by the 
application of a solution of citrate or carbonate of lithium, 5 to 10 
grains to the ounce of water, on lint wound around the parts. Where 
the skin is broken and will not heal, this treatment often permits 
healing by dissolving the crystals in the wound which prevent the 
approximation of the edges and so cause local irritation. Iodine 
ointment or the tincture of iodine is often placed around chronic gouty 
joints with advantageous results. 

A standard remedy in subacute or chronic gout in arsenic, and its 
administration in the form of 3 drops of Fowler's solution, either with 
perfectly pure or lithiated water, is always to be resorted to. If 
anaemia is present arsenic is particularly indicated, and cod-liver oil 
and syrup of the iodide of iron are also of value in this state. 

We find, therefore, in conclusion, that the use of large amounts of 
pure water devoid of salts, and the administration of colchicum, 
potassium iodide, and arsenic are the greater points about which the 
rest of our treatment should centre. In those cases where retrocedent 
gout comes on, the heart must be supported by stimulants, particu- 
larly by hypodermic injections of ether until the slower drugs can 
act, by heat over the belly, by the use of opium to allay irritation, 
except when the brain and kidneys are seriously affected, by the use 
of diuretics and alkaline drinks, and finally by counter-irritation in 
the shape of a mustard plaster placed over the abdomen or chest as 
the case may require. 

HAEMORRHAGE. 

{Including Menorrhagia, Metrorrhagia, Haemoptysis, Hcematemesis, 
Intestinal Hcemorrhage, Hcematuria, and Post-partum Haemorrhage.) 

Under this heading the author will consider all forms of haemorrhage 
which can be controlled by drugs or measures not directly surgical in 
their scope, with the exception of epistaxis, which has already been 
spoken of. 

Whenever a haemorrhage can be arrested by the application of a 
ligature or by compression, as in a cut of the finger or some similar 
wound, no styptic should be used. Styptics are employed for the 
double purpose of constringing the tissues and coagulating the blood, 
and, in consequence, form coagula which tend to make a nasty septic 
mass about the wound. In their place the physician should resort to 
a compress soaked in some antiseptic liquid, or filled with some disin- 



502 DISEASES. 

fectant powder, and if this fails to control the bleeding then ligation 
of the bleeding vessel becomes necessary. 

Where the bleeding-point cannot be reached by direct compression 
or for ligation, the use of packing and of astringents is advisable, 
and drugs which are anti-haemorrhagic should be used by the mouth. 
As these forms of haemorrhage are generally given separate names, 
they will be so considered. 

Menorrhagia is an excessive flow of menstrual blood, either excessive 
in quantity during two or three days, or prolonging itself over an 
unusual number of days, while metrorrhagia is a state in which bleed- 
ing takes place from the uterus independent of menstruation and at 
any period of the month, or even after the menopause has occurred. 

Menorrhagia or excessive menstruation is not to be judged by the 
amount of the flow, but by whether the loss is sufficient to cause 
decrease of health or to indicate disease. In some cases it is a means 
of relieving plethora. 

When the physician decides that something should be done to 
improve the condition of the patient, either in Menorrhagia or me- 
trorrhagia, it will be necessary for him to find out whether any polypi 
or other form of uterine disease is directly responsible for the trouble, 
and in the meantime to employ drugs known to act favorably upon 
uterine haemorrhage. The most prominent of these drugs are ergot 
and oil of erigeroa, the first being the more active and the best remedy 
for active bleeding, the second the better for oozing and for cases where 
there is a continual " show." 

The fluid extract of ergot may be given in varying dose, from 10 
to 60 drops according to the necessities of the case, and the oil of 
erigeron in capsules in the dose of from 3 to 5 minims, or if capsules 
cannot be had, the physician must employ the oil in an emulsion made 
by using syrup of acacia or other similar substance. 

. Where menstruation is irregular and the menorrhagia is almost a 
metrorrhagia, bromide of potassium or sodium in the dose of 10 grains 
once or twice a day is often very serviceable indeed, and the distilled 
extract of hamamelis in the dose of 1 drachm three times a day is 
almost as useful. Cannabis indica, if an active sample is obtainable, 
is also said to be of service, but the writer has never used it to any 
extent. . Oil of cinnamon in the dose of J drachm is very efficacious 
in the slow oozing of some cases where erigeron cannot be used or 
obtained. Sometimes, where cougestion of the pelvic viscera is the 
cause of the trouble dry cups over the sacrum give relief. 

Haemoptysis, or haemorrhage from the lung, is nearly always due to 
tubercular ulceration of a small or large bloodvessel, and the life of 
the patient depends in reality more upon the rapidity with which a 
clot naturally forms than upon the skill of the physician. Though 
text-books order atomized solutions to be inhaled and other remedies 
to be taken by way of the lung, in most cases these measures will be 
found impracticable, simply because the nervousness of the patient 
and the constant cough will not permit of inhalations to any exteut, 
and even if a full breath is taken it generally increases the bleeding 



HEMORRHAGE. 503 

and coughing. The only occasions on which inhalations of styptics 
are of service are those in which the haemorrhage is just beginning, or 
so slight as to streak the sputum or to be at least thoroughly mixed 
with it. The solutions to be so employed must be used in an atomizer 
which will throw a fine spray — sufficiently fine to enter the smallest 
air-tubes with the inspiratory wave of air. A very good fluid is one 
made from Monsel's solution as follows : 

R . — Liquor, ferri subsulphat. . . gtt. xx. to xxx. 

Aquse dest f^iv. M. 

S. — Use in an atomizer every few minutes. 

Or the following : 1 

R. — Acid, tannic gr. xx. 

Glycerini fgij. 

Aquse dest q. s. ad fjiij. M. 

S. — Use in an atomizer. 
Or, 

E. — Aluminis gr. vj. 

Aquse dest . fjiij. M. 

S. — Use in an atomizer. 

Some clinicians advise that the patient should swallow, whether the 
haemorrhage be acute or not, not less than 1 to 1J drachms of the fluid 
extract of ergot, or a solution made by adding 20 grains of gallic acid 
to 1 ounce of water. Tannic acid given by the stomach is not as good 
as gallic acid, because it must be absorbed and changed into gallic acid 
before it can reach the bleeding-point through the circulation. On the 
other hand, the tannic acid if locally used is the better, for it con- 
stringes the tissues and forms a clot, whereas gallic acid does not 
coagulate the blood. There is no doubt that of all the internal 
remedies for haemorrhage from the lungs, aconite is the best. Careful 
studies show that ergot causes primarily an increased flow of blood to 
the lung, although its dominant and final action is to cause contraction 
of the bloodvessels. Haemorrhage from the lung is to be regarded as 
any other haemorrhage. The object of the physician is not to stimulate 
the heart and vasomotor system, thereby increasing the leakage from 
the bleeding vessel, but to lower the arterial pressure to as low a point 
as is safe. The rule to follow is best stated as follows : If the patient 
is seen early in the attack give full doses of aconite to prevent further 
haemorrhage. If when seen so late that he is too much exsanguinated 
to use sedatives, place his head lower than the feet and apply Esmarch 
bandages to the limbs to keep the blood in the vital parts as far as 
possible. The use of stimulants can only increase the haemorrhage by 
increasing the pumping power of the heart and by dislodging the clot 
from the eroded bloodvessel. 

To allay nervous excitement many writers advise that a hypodermic 
injection of morphine should be used. The author is convinced that 

1 If the Monsel does not stop the haemorrhage, the tannic acid will probably fail, 
but more important still, the two should not be used together, as the tannate of iron 
will be formed, which is as black as ink. 



504 DISEASES. 

this treatment is irrational, for morphine is a circulatory stimulant, 
and by increasing the power of the heart increases the haemorrhage. 
Chloral and the bromides are much better remedies, and should be 
given by the mouth. 

Sometimes the patient can point directly to the spot where the 
haemorrhage exists, and under these circumstances a dry cup or a piece 
of ice placed over this point may prove useful. 

After an attack of haemoptysis there is great danger in many cases 
of a traumatic pneumonia being set up by the presence of the ex- 
tra vasated blood. This should be combated by the use of a carefully 
regulated diet, and the reduction of any arterial excitement by small 
doses of aconite in persons not weakened by advanced disease or bleed- 
ing. Complete rest in bed is to be insisted on and no stimulants 
allowed in food or drink, unless the weakness of the patient re- 
quires it. 

Hcematemesis. This depends either upon some injury to the stomach 
or, much more commonly, upon gastric ulcer, cancer, or some other 
severe form of gastric trouble, and is one of the easier of the so-called 
"internal haemorrhages" to treat, because by ordering the patient to 
swallow drugs we can act directly upon the bleeding surface. 1 In 
such a case small pieces of ice should be swallowed frequently, and 
this may be accompanied by 3 drops of MonsePs solution in a half 
tumblerful of water every fifteen minutes till four doses are taken. 
Tannic acid may be given instead in the dose of 20 grains to a drachm, 
but the two should never be given at once to the same case. (See 
foot-note to page 503.) MonsePs salt may be given in pill in the dose 
of 2 to 3 grains. The acetate of lead is also of value in pill form in 
the dose of 2 to 3 grains with morphine or opium. Tincture of the 
chloride of iron, the sulphate of iron, turpentine, ipecac, ergot, and 
hamamelis may all be used, the last three particularly in slow or passive 
haemorrhages. Sometimes nitrate of silver in the dose of \ of a grain 
in pill form is of service if the haemorrhage is a slow one. 

Haemorrhage from the bowel is to be treated according to its point of 
origin. If in the small intestine, as from ulceration of Peyer's patches 
or other glands, the medicines must be used by the mouth, if it be from 
the colon or rectum, or from haemorrhoids, medication must be by way 
of the anus. 

Haemorrhage of the first class is best combated by the taking of 
small amounts of ice by the mouth, and by the use of MonsePs salt 
(ferri subsulphatis). Three grains should be given every half-hour or 
oftener, the pill being made hard enough to reach the intestine without 
being dissolved and decomposed in the stomach. 

Ergot has been largely resorted to, but is of doubtful value, but 
tannic acid may be given with advantage in large amount in solution 
or pill if the MonsePs salt is not obtainable. The other remedies 

1 Hsematemesis also ensues as a result of swallowing blood which has escaped into 
the mouth or naso-pharynx, and this symptom is sometimes induced by malingerers 
in order to further their ends. These forms of hsematemesis should, of course, be sepa- 
rated from those dependent upon some lesion in the stomach itself. 



HEMORRHAGE. 505 

which are of service are sulphuric acid in the dose of 5 to 10 drops 
in water in acute or passive bleeding, or turpentine given in capsule, 
or, better still, in emulsion with acacia in the dose of 10 drops every 
half-hour, particularly where the haemorrhage is not active. Acetate 
of lead and camphor in the following pill may be of service in some 
cases : 

.R:. — Plumbi acetatis . . . . . . gr. v. 

Camphorse . . . . . . . gr. x. M. 

Ft. in pil. no. v. S. — One pill every hour. 

Where the haemorrhage is dependent upon ulceration of the colon 
or rectum, injections are to be resorted to. These are both styptic and 
curative, the styptic injections being particularly useful when the 
bleeding is to be stopped at once, the others where it is sought to re- 
move the condition producing the trouble. 

To the first class belong alnm, sulphate of copper, MonsePs solu- 
tion, sulphate of iron, tannic acid, and cold water. In the second we 
find nitrate of silver, the sulphates of copper and of iron, and the 
chlorate of potassium. 

The alum solution used should be fairly strong, 10 grains to the 
ounce ; the copper, 5 grains to the ounce ; the MonsePs salt, 10 grains 
to the ounce ; or, \ to 1 drachm of the MonsePs solution to each 2 
ounces of water. The tannic acid should be used in the strength of 
20 grains to the ounce of water and glycerin. When chlorate of 
potassium is used it should be employed in saturated solution in small 
injections (25 grains to the ounce), or weaker if the injection be a 
large one (10 grains to the ounce). 

These injections should be carefully given, and the success or failure 
attending the treatment of these states depends as much upon the tech- 
nique of the operation as upon the injection of the medicinal substance. 
It should never be forgotten that an injection designed for local medi- 
cation should be as small in bulk as circumstances will permit. Thus, 
in inflammation of the rectum the amount of the injected liquid should 
not be above 4 ounces at the utmost, and preferably 2 ounces unless 
the diseased area is high up. An enema is given in bulk so as to cause 
distention and excite the bowel to movement, whereas, from a medi- 
cinal injection no movement is desired. Again, the apparatus for 
sending- in the fluid ought not to be a " family " or ordinary syringe, 
but a fountain syringe, the pressure being hydrostatic. This may be 
dispensed with if the injection be small and only intended for the lower 
part of the rectum, but it is indispensable if the injection be intended 
to reach the upper part of the colon. The entrance of the liquid 
should always be gradual and easy. If resistance is met with, the 
pressure must be overcome, not by force, but by waiting a moment 
until it passes off. When the entire colon is to be flooded, at least a 
gallon of warm liquid may be needed. In these cases those drugs 
which are capable of absorption and the production of poisonous symp- 
toms are not to be used except in small amounts. 



506 DISEASES. 

Where the injection is to reach high up into the bowel the patient 
should be put in the lithotomy position with the buttocks elevated. 

Sometimes, in dysentery, the injection of a pint to a quart of ice- 
cold water has a most favorable effect upon bloody purging. 

Whenever a medicated injection is to be used for the cure of ulcers 
which cause haemorrhage, the entire tract which is to be invaded should 
be washed out with pure water or with a saline or soapy liquid, in order 
to dislodge mucus and faeces which prevent the drugs from acting on 
the bowel wall. 

Hoematuria is a condition in which blood appears in the urine, and 
may be divided into two classes : those in which the blood comes 
from the kidney or bladder and those in which it comes from the 
urethra. In the first class the blood is always well mixed with the 
urine, which is changed in color from its decomposition, and appears 
either through the entire act of urination or just at the end of the act. 
In those instances in which the blood is in the first part of the stream 
it arises in the urethra, is nearly pure, and not well mixed with the 
urine. 

If the. blood is due to the presence of an acute nephritis the kidneys 
need treatment, and for directions as to this point the article on Acute 
Bright's Disease should be read ; while, if the haemorrhage is due to 
the presence of a lesion in the bladder, the directions governing the 
use of turpentine, erigeron, or ergot, as given for menorrhagia and 
metrorrhagia, should be followed ; or, if any morbid growth be pres- 
ent, it should be removed. Sometimes 10 to 20 grains of camphor in 
divided doses are of service, given in pill form, while in others can- 
nabis indica is of value. 

Gallic acid, in 20-grain doses, may be used, and is very valuable. 
If the haemorrhage is alarming, injections of astringent washes, such 
as two or three grains of alum to the ounce of water, should be in- 
jected into the bladder. It must be remembered, however, that this 
simply fills the bladder with clots, which are not readily passed and 
are liable to become septic. 

A very useful prescription is : 

IJ. — Acid, gallic. . 3J ; 

Acid, sulphuric, dil. . . . . . f gij. 

Aquae q. s. ad f^iij. M. 

S. — Teaspoonful in water every four hours. 

If the haematuria be malarial, quinine may be employed, but in a 
large number of cases it makes the haematuria worse ; and in the 
southern United States, where severe malarial poisoning is often seen, 
physicians ought rarely, if ever, to use the drug for malarial haemat- 
uria. The value of quinine consists in its ability to prevent future 
attacks rather than to relieve the result of the attack, namely, the 
haematuria. Hyposulphite of sodium is a most useful remedy in the 
dose of 5 to 15 grains every five hours. 

Post-partum haemorrhage is to be controlled by the use of friction 
and kneading or grasping the dilated uterus through the relaxed ab- 



HEMORRHOIDS. 507 

dominal wall; by the use of drachm doses of the fluid extract of ergot 
or a wineglassful of the wine of ergot ; and by the irritation of the 
uterine wall by passing the hand up through the vagina into the uter- 
ine cavity. Sometimes ice may be passed up the vagina and into the 
uterine cavity with success in stopping the bleeding, and even vinegar 
and lemon-juice may be tried if the case is a desperate one. In other 
cases injections of water as hot as can be borne may be resorted to. 



HEMORRHOIDS. 

These painful, annoying, and often serious dilatations of the haeinor- 
rhoidal veins about the rectal opening may be internal or external, 
bleeding or " blind." In nearly every instance where they are promi- 
nent and troublesome the only cure rests in operative measures for 
their relief; but, nevertheless, much can be done for the alleviation of 
the pain and discomfort produced by them. In those cases where the 
haemorrhoids " come down " — that is, pass out by the sphincter and 
become strangulated and sore, the patient's habits should be so arranged 
that his daily act of defalcation is at night before going to bed rather 
than in the morning, as under these circumstances the rest in bed re- 
lieves congestion and soreness which the maintenance of the erect 
posture might make worse. Plethoric persons should not use uphol- 
stered chairs for office or lounging purposes, as the heat of the body 
relaxes the rectal tissues. A cane-seated chair is best, or an air cushion 
with a hollow centre. The liver plays a most important part in rela- 
tion to haemorrhoids, and, if it is congested, congestion of the haemor- 
rhoidal veins is very apt to ensue. The connection between the liver 
and the haemorrhoidal plexus is most intimate, since the plexus is 
formed by the superior haemorrhoidal veins, which are branches of the 
inferior mesenteric, and the middle and inferior haemorrhoidal veins 
which terminate in the internal iliac. The portal venous system is 
composed in part of the inferior mesenteric vein, and any obstruction 
to venous flow in the liver at once results in engorgement of the 
haemorrhoidal plexus. Constipation is nearly always a harmful 
and annoying symptom, and should be relieved by the proper diet 
(see Constipation), and by the use of sulphur or aloes. The latter 
drug has been highly praised and severely condemned by equally 
eminent observers. The author, however, is not favorable to its use. 
In any event the dose of the aloes should be very small, not over 
■^q grain. (For formulae, see article on Constipation.) 

In some cases the injection of a pint of cold water (see Cold) 
in the morning will relieve congestion, and permit an easy evacuation 
of the bowels, or 10 to 20 grains of rhubarb root may be chewed each 
night before retiring. A very serviceable local application is hama- 
melis, either in the form of a lotion or injection (1 drachm to the 
ounce). In other cases it is more convenient to use the fluid extract 
of hamamelis and alcohol, half and half; or, better still, the distilled 
extract of hamamelis, pure or diluted one-half or one-fourth. Great 



508 DISEASES. 

relief is often obtained by inserting into the bowel a pledget of absor- 
bent wool which is wet with the distilled extract of hamamelis, leaving 
a small amount of the wool outside the sphincter so as to act as a sup- 
port to that muscle. Wool is better than cotton, because when wet it 
still retains to some extent its shape and elasticity, whereas cotton be- 
comes hard and sodden. Sometimes either of these preparations may 
be used internally with advantage in the dose of 10 to 20 minims of 
the former or 1 to 2 drachms of the latter. An ointment of gallic 
acid and opium is of value, made as follows : 

fy. — Acid, gallic. gr. x. 

Extract, opii . . . . . . gr. iv. 

Extract, belladonnse . . . . . gr. iv. 

Ung. simplicis %iv. M. 

S. — Apply night and morning. 

Probably no other service is more apt to provoke everlasting grati- 
tude on the part of the patient than the cure or alleviation of haemor- 
rhoids. The physician who does not resort to purely surgical measures 
may use a drop of strong acetic acid or carbolic acid on each pro- 
truding mass, or strong nitric acid may be similarly employed. The 
injection of a drop of carbolic acid into a haernorrhoid often acts 
exceedingly well, but it will, once in a great while, cause a bad 
slough. 

For the surgical treatment of piles, reference must be made to 
surgical works. 

HEADACHE. 

(For Neuralgic Headaches, see Neuralgia. For Bilious Headache, 

see Biliousness.) 

Probably no single source of pain compares in its frequency to 
headache, chiefly because it is essentially a symptom of many diseased 
processes or functional disturbances and nothing more. It may arise 
from eye-strain, from brain disease, from anaemia, from uraemia, from 
plethora, from nervous breakdown, and from a multitude of causes 
which, if they were all recounted, would cover many pages of this 
book. The only forms of headache which will be considered here 
are those due to congestion or which arise from fatigue. 

Congestive headaches, dependent upon an engorgement of the cere- 
bral vessels with blood, are to be treated in a number of ways, and if 
any direct cause of congestion can be discovered, this must, of course, 
be removed. So far as the direct application of drugs is concerned 
we find two methods of promoting a cure. The first consists in the 
use of ergot, which will cause contraction of the dilated vessels, the 
second in the employment of vascular sedatives which will produce 
arterial depression and so remove congestion. Sometimes one of 
these methods will succeed where the other fails, and it is almost 
impossible to tell, beforehand, which case should have one drug and 
which another. It is to be remembered that when the congestion is 



HEADACHE. 509 

due to vascular relaxation and weakness the vascular sedatives are 
contra-indicated. 

The use of a hot mustard foot-bath is of great value, and a mus- 
tard plaster or cup applied to the nape of the neck is often of service 
in congestive headaches, while in severe cases an ice-bag applied to the 
head, or leeching behind the ears or on the temples, may be resorted 
to. Bleeding often gives relief at once in severe congestive headache. 

Where headache depends upon fatigue, either general or local, 
stimulating treatment is necessary. If eye-strain be the cause, full 
doses of strychnine or mix vomica are of service. These cannot be 
used if there is much retinal irritability. And in many instances a 
combination of caffeine, bromide of potassium, and antipyrine is very 
successful, as follows : 

R . — Caffeinse citratis gr. xl. 

Potassii bromidi 3 iv. 

Antipyrini gij. M. 

Ft. in chart, no. xx. S. — One powder in water as needed 

Sometimes the caffeine makes the headache more acute, and if this 
occurs only the autipyrine can be used. 

Sleep is generally a more useful prescription than any drug, and if 
city life creates so much mental anxiety during the day as to be wear- 
ing upon the nervous system, or make the patient wakeful at night, 
business must be put aside and health and recreation sought at a 
watering-place. Horseback exercise is very useful indeed, and should 
be resorted to by all who can afford it if they are sufferers from ner- 
vous headaches. 

A form of headache which is often very severe, sometimes fleeting, 
sometimes persistent, is that due to gout, and it is to be treated by 
means quite distinct from those named so far. Some practitioners of 
wide experience employ salicylic acid in doses of from 5 to 15 grains, 
while others rely on the iodide or acetate or potassium. In cases 
where anaemia is present, Peabody uses the following prescription, 
which is compatible, whereas most of the preparations of iron and 
salicylic acid are incompatible : 

ft. — Acid, salicylic gr. xx. 

Ferri pyrophosphat gr. v. 

Sodii phosphatis . . . . . gr. j. 

Aqua? dest fgss. M. 

S. — This is to be taken every three hours. 

Cohen has used the following, which is more pleasant to the taste : 



M. 



. — Sodii salicylatis 

Glycerini .... 
01. gaultheriae 
Tr. ferri chloridi . 


^iv. 

• • • f&j. 
TTtxx 
. f^iv. 


Acid, citrici .... 


gr. x. 


Liq. ammonii citratis, B. P. 1 . 


q. s. ad f ^ iv. 



S. — Dessertspoonful in water twice, thrice, or four times a day. 



1 Liquor ammonii citratis, B. P., is made by adding five fluidounces (imperial 
meas.) of strong solution of citrate of ammonium to fifteen fluidounces (imperial 



510 DISEASES. 

Other cases of a gouty headache require colchicum, particularly if 
the gout be widely distributed in its manifestations, and to these 
Hamilton gives 

R. — Vini colchici seminis f^ss. 

Potassii acetatis "J 

Potassii iodidi > . . . aa f^v. 

Tr. cimicifugse racemosse J 

Aquse q. s. ad f Jj iv. M 

S. — Teaspoonful every four hours. 



HEART DISEASE. 

(For Treatment of Angina Pectoris, see page 391.) 

The writer classifies all forms of heart disease under this heading 
advisedly. In valvular disease the profession are beginning to under- 
stand more and more that the mere destruction or laming of this valve 
or that has little to do with the treatment, although the ultimate 
result of the case is somewhat dependent upon these conditions. It 
matters not whether the leak in a valve be minute or huge, provided 
the heart can still do its work ; the condition of the cardiac muscle is 
the important factor to be considered. If an irreparable leak exists 
in a pump the question is not, Can we cure that leak? but rather 
whether we can work the pump with enough force and rapidity to 
obtain all the water needed for the maintenance of life. Some physi- 
cians use heart tonics, such as digitalis, whenever they find a valve 
diseased, as if to mend the broken valve. Nothing can be more 
erroneous, for a valve once injured is never regenerated. 

It should be an invariable rule with every physician in examining 
a patient with heart disease to determine whether or not the tissues 
of the body receive their normal blood-supply. If they do not, even 
though the leak is so small as to escape notice, digitalis or other tonics 
are to be used ; but even if the murmur heard on auscultation is as 
loud as that of a machine-shop, and the tissues are not starved, no 
remedy is needed. 

Another very important point in regard to the treatment of cardiac 
disease in children, is the remembrance that the stunting of the body 
and the slowness of growth are not merely the result of heart trouble, 
whereby the tissues do not increase in size from lack of nourishment, 
but occurs for a special purpose. Supposing that a child of eight or 
nine years has scarlet fever or rheumatism, which leaves the cardiac 
valves impaired in function. For a few days, or hours at least, the 
question must arise in the heart : " Can I fill all the bloodvessels 
properly ?" If the heart can supply the vessels the child lives, but is 

meas. ) of distilled water. The stronger solution of citrate of ammonium is made by 
taking twelve ounces (avoirdupois) of citric acid, strong solution of ammonia eleven 
fluidounces, and adding enough distilled water to make twenty-four fluidounces (im- 
perial meas.). 



HEART DISEASE. 511 

stunted because Nature is wise enough to understand that the struggling 
heart has all it can do to supply even a stunted frame, and realizes 
that a rapidly increasing area of bloodvessel surface in a growing 
child would exhaust the cardiac muscle. 

The physician should not endeavor to make such a child grow by 
gymnastics or tonics, but should direct his attention to the care of the 
general health, and particularly that of the heart, for as soon as this 
organ is strong enough to permit of growth, growth will take place. 

Having made these preliminary remarks, let us turn to the direct 
application of drugs to heart disease — the chief drug in the list being, 
of course, digitalis. 

The value of the digitalis may be said to rest upon a number of 
influences possessed by it. In the first place, evidence is constantly 
accumulating to show that digitalis increases the nutrition of the 
heart muscle by the stimulating influence which it exerts over the 
pneumogastric nerve ; this nerve having been partly proved to be a 
trophic nerve of the heart. Aside from any such nervous influence 
the heart muscle receives a greater blood-supply under the use of digi- 
talis, since both diastole and systole are influenced by the drug, the 
systole being more complete and the diastole being prolonged and more 
extensive. 

Two theories concerning the nutrition of the heart muscle through 
its blood-supply have been promulgated. One is, that the coronary 
arteries are filled with arterial blood as the heart drives its contents out 
of the left ventricle, or, in other words, during systole. The other 
hypothesis rests upon the belief that the contracting muscle prevents 
a free circulation of blood through the cardiac bloodvessels, and that 
the blood is driven into the coronary arteries during diastole by the 
pressure in the aorta, the aortic valves being closed. In the belief of 
the author both of these theories are partly true. That is to say, the 
coronary arteries are filled during ventricular systole, according to the 
first theory, but the complete passage of the blood through the smaller 
vessels of the cardiac muscle only takes place as relaxation or diastole 
occurs. The ground for this belief consists in the observation that a 
muscle when firmly contracted always presses upon its supplying 
bloodvessels, and particularly interferes with capillary flow. The heart 
of one of the lower animals, if carefully watched after the chest- wall is 
removed, will always be found to become paler during systole and 
redder during diastole, and if wounded will bleed more freely during 
the relaxing period than during the contraction of its fibres. As the 
blood everywhere in the body nourishes the tissues, not when in the 
arteries, but while passing through the capillaries, it would seem self- 
evident that, while the coronary arteries are filled by the systole or 
contraction of the heart, the nutritive changes and perfect capillary 
circulation go on during diastole. If these things are true, the increase 
in cardiac nutrition and growth under the action of digitalis is only 
what one would expect, for we have learned when studying this drug 
that it prolongs diastole and increases the force and volume of the 
systolic wave of blood. In other words, digitalis fills the coronary 



512 DISEASES. 

arteries almost to bursting, and so, when diastole occurs, not only floods 
the cardiac capillaries with blood but prolongs the period during 
which the interchange between the blood-stream aud tissues takes 
place. 

There is still another way in which digitalis does good in cardiac 
disease by reason of its peculiar powers. Normally, the heart beats 
fast or slow according to the demands made upon it by the system for 
blood, and its action is varied by the calls which it receives from the 
tissues. In heart disease, owing to the leaky valves, the tissues are 
starved, and continually send messages for more nourishment to the 
cardiac muscle, which finally becomes exhausted by its endeavors to 
supply their wants, and beats now fast and now slow, uncertain what 
to do. If digitalis is given, the vagi render the cardiac action regular 
and effective, acting as regulators and directors of its energies, thereby 
supplying the tissues and using the remaining power of the heart to 
the greatest advantage, in addition to improving its blood-supply by 
the methods already described. The starving tissues of the body hav- 
ing been satisfied, as Dr H. C. Wood has eloquently expressed it, a the 
angry messengers from the periphery cease their callings, and the heart 
is at peace and in comfort." 

From what has been said it becomes evident that this drug, digitalis, 
does good whenever the heart is weak or unable to supply the body 
with blood, and we find for this reason that cardiac dilatation, simple 
cardiac failure, or heart failure dependent upon the presence of poisons, 
all indicate its use. 

The mechanism of the action of digitalis in the different cardiac 
lesions still remains to be described. 

Taking up the most common condition, that of mitral regurgitation, 
we find that in this disease the blood passes, in its normal flow, from 
the auricle into the ventricle, and, when the ventricle is filled, that 
the cardiac muscle contracts on all sides equally. Normally, the 
mitral valves close the auriculo-ventricular opening and prevent any 
of the blood from regurgitating back into the auricle, and the greater 
the pressure the tighter they become. Abnormally, the blood is still 
pressed upon on all sides as before, and, trying to escape, as do all 
liquids, from pressure, finds that, owing to disease of these valves, it 
can, in part at least, slip back into the auricle from which it came, 
rather than pass out into the high pressure of the arterial system. 
The ventricle, therefore, propels blood in two directions — in the wrong 
way and in the right way. If the leak is large enough to carry off 
more blood than the aorta, then death occurs. Digitalis, under these 
circumstances, does good, because, by increasing the force of the ven- 
tricle, it increases the friction at both the mitral leak and the aortic 
opening ; but, as the aortic opening is a large one and the mitral leak 
a small one, the greater quantity of blood passes out into the circula- 
tion. The same fact arises for consideration as before, namely, that 
it is not the amount of leak, but the amount of supply to take its 
place, which is the vital question in the case. Sometimes relief does 



HEART DISEASE. 513 

not occur, and the patient is made worse by digitalis, because the leak 
is increased as much as the normal flow. 

In mitral obstruction the difficulty is that the blood cannot enter the 
ventricle with sufficient rapidity, and this part of the heart contracts 
before it is well filled. By the prolongation of diastole the blood is 
given sufficient time to enter, and the ventricle is filled, sending out 
into the system a large wave of blood when it contracts. Further 
than this the stimulation of the right ventricle by the digitalis enables 
this part of the heart to overcome the tendency to congestion which 
arises through the obstruction on the left side of the heart. 

In aortic stenosis there is obstruction to the normal flow of blood 
out of the heart, and the digitalis is needed to increase the ventricular 
force, so that it may overcome the difficulty. 

In aortic regurgitation, digitalis, by its stimulation of the heart, 
may cause a sufficient output of force to clear itself of the regurgitant 
flow, but in many cases the drug fails, because the prolongation of 
diastole gives so much more time tor the blood to flow backward into 
the dilating ventricle. The cardiac remedies to be used in such cases 
are strophanthus, in the form of the tincture, dose 3 to 5 drops, adoni- 
din, dose £ to J- grain, or sparteine, \ grain. These remedies may 
also be used in the other forms of cardiac disease where digitalis fails. 
It is important to remember, however, that some cases of aortic regur- 
gitation do improve, at least temporarily, under digitalis. 

In cardiac dropsy digitalis and the other heart stimulants do good 
by raising blood-pressure and pulse-force. (See Dropsy.) 

In cardiac palpitation dependent upon indigestion, this condition 
must be relieved by appropriate digestive remedies ; but in that form 
of palpitation due to over-exertion or heart-strain digitalis is useful. 
Sometimes aconite or veratrum viride are very serviceable in palpita- 
tion, if the cardiac condition is good, and iron is to be used if the irri- 
tability is due to anaemia. Tea, coffee, tobacco, and excessive venery 
are to be forbidden. Sometimes nux vomica does good by stimulating 
the heart and nervous system, and belladonna seems of great value 
where arhythmia is present. Ringer recommends the use of veratrine 
ointment over the prsecordium in some of these cases. 

In sudden cardiac failure from weakness or poisons the use of ether 
and ammonia is to be resorted to at once, aud these are to be followed 
by alcohol and digitalis, if necessary. The ammonia is a direct heart 
stimulant, as are also the alcohol and ether. 

Cardiac hypertrophy is rarely seen without some other lesion accom- 
panying it, but it* may occur from prolonged and excessive exercise or 
other cause. It is to be treated by aconite, veratrum viride, perfect 
rest, and avoidance of exercise, and by the use of moderate amounts 
of food of a non-stimulating character. Wines and coffee should be 
forbidden, and veratrine ointment may be placed over the prsecordium 
if the action of the heart is very excessive. 

An exceedingly useful treatment of excessive cardiac hypertrophy is 
rest in bed, with or without medication. The results in some cases are 

33 



514 DISEASES. 

extraordinary, whether the hypertrophy be due to valvular disease or 
other cause. 

Fatty heart occurs in two forms : that in which true fatty degener- 
ation has taken place in the muscular fibre and that in which there is 
a deposit of fat between the fibres. Nothing of any importance can 
be done for the first state, but much for the second. The patient suf- 
fering from this latter form of heart trouble is nearly always obese, 
and should suffer abstinence from fats and rich foods, from all sweet 
wines or malt liquors, from sugars and milk, and, at the same time, 
take exercise. At first this treatment may cause dyspnoea, but by 
gradually increasing the severity of the exercise great feats can gen- 
erally be effected in the end, with marked improvement in the cardiac 
action. (See Obesity.) 



HEPATITIS. 

(Acute and Chronic Hepatitis, and Hepatic Abscess.) 

Inflammation of the liver may be produced by many causes, such 
as injuries, cold, exposure to high heat (as in the tropics), syphilis, and 
the presence of any infectious disease or of parasites. It may also arise 
from alcoholism. The acute form is rarely directly produced by 
syphilis unless by the presence of some other form of the disease, such 
as gumma, or the absorption of septic materials into the circulation 
from wounds or sores. The same may be said of the hepatitis of hot 
climates, which is generally subacute or chronic. The pain, swelling, 
and general symptoms of the acute form of inflammation of the liver 
are described thoroughly in the text- books on the practice of medicine. 
The measures commonly adopted for the relief of the symptoms and 
the disease itself are of two kinds : the first, medicinal ; the second, 
dietetic. 

The patient, if the attack be acute or severe, will commonly be 
found in bed owing to the pain and fever, but, if not, he must be 
placed in bed and kept in a recumbent posture. Over the surface 
of the right hypochondrium should be placed two cantharidal blisters 
of the diameter of from 1 to 3 inches, or, if this is not possible, a 
large mustard plaster is to be used. Sometimes hot cloths applied 
over this area not only give relief, but also aid in the formation of 
the blister. At the same time, if the bowels are greatly confined, a 
saline purgative may be given, and be preceded by 1 grain of calomel 
given in fractional doses. In regard to internal medication the physi- 
cian should recollect that hepatitis is, like every inflammation, a local 
hyperemia or vascular engorgement, and, in consequence, that aconite, 
in full doses, is useful. Veratrum viride may be used, but as it may 
produce vomiting and disturb the liver it should rarely be employed. 
The kidneys may be kept active by spirit of nitrous ether and citrate 
of potassium, or by any one of the diuretic waters, such as Vichy in 
moderate quantities. If the inflammation is not aborted by this 



HEPATITIS. 515 

treatment it will go on to hepatic abscess. 1 If hepatic abscess develops 
the best thing to be done is to aspirate and draw off the pus. Very 
frequently the inflamed organ will form so strong an attachment with 
the peritoneal coat of the abdominal cavity that a bistoury may be 
used to free the pus if an aspirator is not at hand. After pus is once 
formed any constitutional evidence of its presence, as by night-sweats, 
hectic or rigors, is a sign for immediate interference with the purulent 
collection by the physician. If dysentery exists it must be cured as 
rapidly as possible by the measures generally employed for this pur- 
pose. (See Dysentery.) 

The diet during the early and later stages of acute hepatitis is 
almost identical, and may be resorted to in the subacute and even in 
the chronic forms of the disease. It should consist of koumyss to a 
great extent, or matzoon may be employed, but " strong foods/' such 
as meats of all kinds, particularly beef, pork, and mutton, are to be 
sedulously avoided. All spices in the food must be forbidden, and 
alcohol utterly tabooed. If koumyss cannot be had the patient may 
be fed on peptonized milk or pancreatized oysters. (See page 373.) 
After the abscess develops, the same recommendations are to be fol- 
lowed, and the diet is to be as supportive as possible, small doses of 
quinine being used. 

In the treatment of the subacute or chronic hepatitis of hot cli- 
mates no remedy compares to freshly prepared strong nitro-muriatic 
acid used both externally and internally. The acid should be a deep 
orange color, and be mixed with water only when about to be taken, 
in the dose of 3 to 4 drops three times a day. This remedy is contra- 
indicated in acute hepatitis, because it acts in the chronic form of the 
disease by stimulating the organ up to its normal tone, and would 
only increase the severity of the acute form of the disease if adminis- 
tered at this time. Externally, it is to be used by mixing it with 
water and applying it by means of a flannel wrung out in the mixture, 
or by placing it on spongiopiline in the proportion of from 1 to 3 
fluidrachms to the pint of warm water and applying it over the liver. 
If 3 fluidrachms irritates the skin too greatly the smaller quantity 
should be employed. This application causes a tingling of the skin 
and a localized sweat. 

The hepatitis due to syphilis generally shows itself as a cirrhosis, 
and is to be treated by anti-syphilitic measures. (See Syphilis.) 

If ascites develops from cirrhosis the liquid is to be withdrawn, 
and frequent aspirations, as often as the liquid returns, have been 
known to result in fiual cure or arrest of the disease. In all forms of 
chronic hepatitis iodide of potassium is a useful remedy in the dose of 
from 5 to 10 grains three times a day, or larger amounts may be used 
if the case be due to syphilis. 

1 Just here it may be well to recall that many cases of hepatic abscess are now 
known to be due to dysentery, and that the diseased state of the lower bowel may 
infect the liver. 



516 DISEASES. 



HICCOUGH. 

This is an affection* arising from many causes, depending upon irri- 
tability of the nerves supplying the diaphragm as a result of gastric 
irritation, nervousness, uraemia, and as a complication of several ex- 
hausting diseases, such, for example, as typhoid fever. 

The mechanism of its production rests upon the sudden contrac- 
tion or descent of the diaphragm, whereby a vacuum is formed in the 
chest into which the outside air attempts to rush, but is prevented 
from doing so by a sudden closure of the glottis, the peculiar sound 
of the hiccough being thus developed. Generally the symptom stops 
of itself, but it may become excessive. 

The remedies to be employed are used according to the cause of 
the disorder. If there be gastric or intestinal irritation, the irritating 
matter must be removed by emetics or purges, and nervous and local 
sedatives used. A few drops of spirit of chloroform do good in many 
cases, and a little tincture of capsicum may be employed in other 
instances, say 2 or 3 drops well diluted. Children should only have 
i to 1 drop of the tincture, well diluted. Spirit of camphor, or the 
tincture of valerian, in the dose of 1 drachm, may be serviceable, and 
Hoffmann's anodyne is peculiarly appropriate. In the hiccough of 
typhoid fever nothing compares to musk, 10 grains by the rectum, and, 
if this cannot be used, oil of amber may be given in the dose of 5 to 10 
drops in capsule or emulsion. Nitrite of amyl may also be inhaled. 

Where external remedies are resorted to, ether thrown in a fine 
spray on the epigastrium may stop an attack. 

In cases where the affection comes on after meals, and is due to in- 
digestion, a course of tonic treatment will often give relief. Thus 
nux vomica in pill or tincture, accompanied by some dilute mineral 
acid, such as hydrochloric or nitric, may be employed. 

If the symptom be due to uraemia, a hypodermic injection of hydro- 
chlorate of pilocarpine will be found of service unless it is contra- 
indicated by advanced depression and systemic weakness. 



INCONTINENCE OP URINE. 

Incontinence of urine may be classified either according to its forms 
or the methods of its treatment. 

Four varieties may be recognized as occurring separately, although 
all of them may occur in one case. There are cases where the bladder 
fails to hold the urine day or night, those in which the incontinence 
is only nocturnal, and those in which it occurs only upon some ner- 
vous start, or in which the sphincter becomes relaxed from general 
atony. The first of these occur in children, the last in adult females. 
A fourth form of incontinence depends upon paralysis arising from 
centric nervous disorder or from paralysis due to retention and conse- 
quent paralytic distention. 



INCONTINENCE OF URINE. 517 

Taking up the consideration of the first forms, namely, those occur- 
ring in children, in which the trouble is generally nocturnal, the com- 
plete history and the present condition of the case must be discovered. 
Many of the most obstinate cases will yield when the urine is made 
clear and mild by the use of alkalies, and others will recover upon 
the removal of worms from the vagina, which have crawled there 
from the rectum, or upon circumcision of a redundant prepuce, par- 
ticularly if this be tight and smegma and urine be found back of it 
in large or small quantity. The cause of the incontinence in both 
these conditions is reflex irritation, exercised by the urine on the 
bladder walls or by irritation at the end of the penis or in the vagina, 
and the reason that alkalies do good is that they render the urine, 
which is concentrated and irritating, dilute, alkaline, and mild. Bella- 
donna in these cases is rarely, if ever, curative, and is at most only 
palliative, the condition returning as soon as the passing off of the 
effects of the drug permits the irritation to be felt by the nerves of 
the bladder. After alkaline diuretics have been used, belladonna is, 
however, very valuable. 

Where the urine is concentrated and dark in color, the following 
prescription is always useful : 

R. — Potassii citratis ^ss. 

Spt. aetheris nitrosi f^vj. 

Aquae q. s. ad f Jj. M. 

S. — Dessertspoonful every four hours in equal quantity of water. 

As the urine becomes clear, after several days, a few drops of tinc- 
ture of belladonna may be added to the mixture ; but if a little is not 
sufficient it must not be increased, as belladonna will not cure the 
condition, and may make the urine concentrated — a condition directly 
opposed to that which is wanted. 

Sometimes these cases are dependent not so much upon vesical irri- 
tability as upon weakness of the spinal centres governing the bladder. 
If this be the case the remedies used should be directed to the im- 
provement of these parts, and the following pill should be adminis- 
tered, or the succeeding solution : 

R • — Acid, arseniosi gr- 3 • 

Extract, nucis vo micas . . . . . gr. ij. M. 
Ft. in pil. no. xx. S. — One three times daily after meals for a child of eight or 
ten years. 

Or, 

R . — Liquor, potassii arsenitis . . . . gtt. xxiv. 
Tinct. nucis vomicae ..... gtt. xvj. 

Aquae q. s. ad f ^ iij . M. 

S. — Teaspoonful three times daily after meals for a child of eight or ten years. 

This mixture is so bitter as to be exceedingly disagreeable, and 
Fowler's solution may often be used alone in the dose of J to 1 drop. 
And at the same time strychnine in gelatin- or sugar-coated pill or 
granule. 

It must be remembered that this last treatment is only to be em- 



518 DISEASES. 

ployed in chronic cases devoid of all irritation and dependent upon 
atony. It will not do good if the urine is not previously made clear. 

Nothing can be more unfortunate in the treatment of these cases 
than punishment by severe scolding and whippings, as it never does 
good, and the fault being beyond the child's control the unjust punish- 
ment makes him sullen, or through nervousness, augmented by such 
treatment, his trouble becomes worse. In some cases it may be neces- 
sary, in order to cure the habit, to let the child drink diuretic waters 
for years, and the patient should always be taken up from bed when 
the parents retire for the night and made to evacuate the bladder. 

In the incontinence of adult females or males, on laughing or sud- 
den movement, nothing compares, from a curative point of view, to 
drop doses of tincture of cantharides three times a day, the urine 
being kept flowing freely from the kidneys by means of alkaline 
diuretics. 

The treatment of the fourth form of incontinence of urine comes 
into the province of surgery. The bladder must be relieved by the 
catheter if the trouble be from retention. If the disorder is due to 
paralysis nothing can be done except to carry out those general measures 
valuable in such cases, to maintain the urine in as normal a state as 
possible, to frequently catheterize with an aseptic catheter, and to wash 
out the bladder every few days or hours, as the case may be, with some 
weak antiseptic fluid such as the 1 to 10,000 solution of bichloride of 
mercury, or 1 to 100 of carbolic acid, or 1 to 100 of boric acid. 



INDIGESTION, GASTRIO AND INTESTINAL. 

Under the heading u Biliousness " the writer has already described 
many of the conditions arising out of indigestion, and this being the 
case the consideration of that state known as dyspepsia or indigestion 
will only receive attention at this point in so far as its cure is con- 
cerned, without the relief of the symptoms produced. 

Lack of gastric digestion depends for its existence upon a very great 
number of causes, and is always a symptom, not a disease. It occurs 
during the course of short or prolonged fevers, from atony of the gastric 
walls and glands, from lack of secretion of the proper character, from 
hypersecretion of mucus by the mucous glands, and by fermentative 
changes in the food, or as the result of any one or all of these condi- 
tions ; and lastly, because the food is unsuitable to the case or is of a 
kind difficult of assimilation, or is readily split up into effete products 
by the juices of the organ. Sometimes it is due to organic changes in 
the viscus, as carcinoma or ulcer, and sometimes to acute or chronic 
gastritis. In each of these states the treatment is, of course, different. 

The indigestion attendant upon the course of fevers can nearly 
always be avoided by a proper diet and the use of predigested food, 
such as pancreatized beef-tea, milk, or broths. 

The necessity of this artificial digestion is the more readily recog- 
nized when we recall the investigations of Hoppe-Seyler upon the 



GASTKIC AND INTESTINAL. 519 

quality of the gastric juice of a patient suffering from typhus fever, 
for he found that no hydrochloric acid was present. Uffelmann has 
also found in a similar study that the peptone-forming secretion of the 
stomach ceases entirely during fever. 

Generally, if the accompanying disease is adynamic in type, alcohol 
should be taken with the food, so that the stimulating effect of the 
drug will cause gastric and intestinal activity. A very important 
point to be remembered, is that the exercise of the function known as 
digestion requires force, and that digestion fails in cases of prolonged 
fever because the system lacks the force required to carry out the act. 1 
As alcohol adds force to the system it aids digestion and should be 
varied in the amount given according to the state of the organism, 
and particularly that of the stomach itself. During convalescence 
from fevers or other acute diseases the digestive functions are to be 
kept up to their work by bitter tonics and a gradual decrease in the 
amount of alcohol insisted upon, lest the alcoholic habit be set up. 
The tonics may be given in the formulae to be found below if so 
desired. 

In the gastric atony dependent upon overwork or fatigue of mind, 
as well as body, tonics are to take the place of alcohol, as this drug is 
peculiarly apt to give rise to the alcohol habit in such cases. These 
tonics ought always to be bitter and should chiefly depend for their 
activity upon this property. The most powerful of them are mix 
vomica, or its alkaloid strychnine, and quinine, both of which drugs, 
however, exercise a more powerful effect on other parts of the body 
than on the stomach. The other bitters are gentian, cardamoms, 
quassia, chiretta, and calumba, all of which may be used with great 
success in combination with one another or alone. 

The following formulae are useful, but before naming them it is 
proper to call attention to the fact that all tonics are contra-indicated 
if any irritation of the stomach is present, because they are stimulants 
and irritate the gastric walls all the more if these are already inflamed. 

I£. — Extract, nucis vomicae gr. iv. 

Extract, quassias gr. xx. 

Quininae sulphatis gr. xl. M. 

Ft. in pil. no. xx. S. — One pill three times a day after meals. 

Or, 

Ije. — Tr. nucis vomicae f^j- 

Tr. cinchon. comp q. s. ad f Jiv. M. 

S. — Teaspoonful after each meal. 

Or, 

Be . — Extract, chiratae gr. xl. 

Extract, gentianae . . . . . . gr. xl. 

Oleoresinae capsici ...... V(\v- M. 

Ft. in pil. no. xx. S. — One after each meal. 

1 Very few of us realize the amount of force used up in the body in daily life. It 
is almost impossible to estimate the amount used in digestion, but we know that 
glandular secretion is very powerful, so powerful in the salivary glands as to be 
twice that of the blood-pressure in the carotid artery, if necessity requires it. 
(Ludwig. ) 



520 DISEASES. 

Where the failure of digestion rests upon a deficient secretion and 
it is desired to increase the rapidity of the act by purely artificial 
means, we may rely upon pepsin and hydrochloric acid, but if this is 
done it should be resorted to with a clear idea of why such remedies 
are prescribed. 

Very commonly, in the treatment of gastric dyspepsia proper, pepsin 
is given in such absurdly small doses as to be almost useless, and yet 
the prescription as it is taken is intended to aid the true gastric juice 
which is not thought strong enough to be capable of performing its 
functions aright. This is not by any means the result attained, in the 
majority of cases, for the following reasons — indeed, the direct diges- 
tive action of the dose administered probably brings about the smallest 
part of the good achieved : 

It is a mistaken idea to believe that pepsin and hydrochloric acid 
are simultaneously secreted and utterly independent bodies, or, in 
other words, that the pepsin may be formed even if the glands fail 
to form the acid. We know, from the experiments of Heidenhain 
and of Langley, as well as many others, that pepsin, as such, is not 
secreted by the glands ready formed, but that these tubules secrete a 
so-called " mother substance " called pepsinogen, which is absolutely 
impotent until it is changed into pepsin in the presence of hydro- 
chloric acid or sodium chloride. Consequently, we learn that the two 
digestive elements are very closely associated, and that the absence of 
acid means absence of pepsin. 

In normal life this acid is derived by the splitting-up of the chlor- 
ides iu the blood supplying the glands by the lactic acid which is 
present almost constantly in the stomach, owing to the decomposition 
of carbo-hydrates. This assertion, made by Maly, is also confirmed 
to some extent by Julius Thomsen, who has shown that very weak 
acids may displace stronger ones from their bases, and even appro- 
priate the greater part of the base. This is doubtless the reason why 
common salt is so useful a condiment, since it is brokeu up in the 
stomach, thus setting free hydrochloric acid, besides keeping up the 
alkalinity of the juices of the body which is so necessary to health 
and the future secretion of gastric juice. It also explains in a very 
ingenious manner the w r ell-known fact that salt added to a glass of 
milk increases its digestibility to a great degree. Further than this, 
the usefulness of the salt taken in small amount before meals does 
not depend entirely, as has been thought, upon an endeavor on the 
part of the stomach to neutralize the sodium present in a normally acid 
medium, whereby an excess of gastric juice is secreted, but upon the 
reasons given above. We find, therefore, that in cases where there is 
reason to believe that gastric digestion is imperfect, common salt 
should be used in increased amount in the food so that the quantity 
of hydrochloric acid may be increased. If, however, there is reason, 
to believe that lactic acid is present in too small a quantity to split up 
this salt, then hydrochloric acid must itself be used, and, where it is 
employed, given freely in order not only to act thoroughly so far 
as its own functions are concerned, but also to perform an equally 



GASTKIC AND INTESTINAL. 521 

important function, namely, the conversion of pepsinogen into the active 
ferment pepsin. In other words, deficiency of pepsin in the juice is 
to be corrected, not by a prescription containing much pepsin and a 
little acid, but rather the reverse, for the pepsin in the prescription is 
after all an extraneous product, while the pepsin brought into being 
by the acid is a normal secretion. Of course, the quantity of pepsin 
must depend on a normal formation of pepsinogen ; but it should not 
be forgotten, on the other hand, that as pepsin acts by catalysis, and is 
a most powerful ferment, only very small quantities of it, compara- 
tively speaking, are absolutely necessary, while large amounts of 
hydrochloric acid, comparatively speaking, are essential. 

Bourget has enunciated views which are so completely in accord 
with the views here expressed as to be worthy of quotation. He 
believes, as does the writer, that the hydrochloric acid is generally the 
secretion which is lacking in amount and recommends its free em- 
ployment as the most important part of the treatment of gastric 
indigestion. He does not do this because he believes it to increase 
the pepsin, but only because he thinks the acid formation is more apt 
to be deranged than is that of the ferment. According to practical 
experience, and the equally reliable information gaiued by experimental 
research, it is to be concluded, therefore, that pepsin is to occupy the 
least prominent position in a prescription for gastric indigestion, and 
that the acid is to be freely used. 

Where indigestion results from the presence of gastric catarrh the 
remedies applicable to such a state must be resorted to. (See Gastric 
Catarrh.) 

In many cases in which distress comes on some time after eating, 
the trouble is due to the development of large amounts of lactic and 
butyric acid in the stomach, and the remedies to be given, unless 
the patient will cause himself to vomit by tickling his pharynx or 
swallowing an emetic, are sodium bicarbonate or ammonia. Some- 
times patients go from physician to physician without relief, only to 
find it when someone gives them 10 to 20 drops of the aromatic 
spirit of ammonia for each attack. 

Salol may also be given in the dose of 10 grains three times a day 
in many of these cases with very extraordinary results, as may also 
■^q grain of podophyllin morning and night. 

In other cases the cure of this condition rests upon the removal of 
the state of atony or dilatation of the gastric walls. (See Gastric 
Dilatation.) 

Intestinal indigestion depends upon almost the same causes as does 
gastric dyspepsia, and is to be treated in much the same manner, 
chiefly by a careful study and regulation of the patient's diet, and by 
the use of a number of remedies calculated to supplant to some ex- 
tent the normal juices by some artificial ferment. These ferments 
should be given with the meals, or the food predigested before it is 
taken. 

The pancreatin should be given in good dose (5 to 10 grains), with 



522 DISEASES. 

bicarbonate of sodium, and alkaline mineral waters used if the urine 
is concentrated. (See Biliousness.) 

Sometimes where intestinal indigestion is present great flatulence 
eornes on and is an annoying symptom. Very commonly in these 
cases it will be found that the patients think they have heart disease, 
because of the pain they suffer under the prsecordium. This pain is 
due to the accumulation of flatus in the small intestine, or more com- 
monly to its pressing upward at the angle where the transverse colon 
turns to go down to form the descending colon and sigmoid flexure. 
Under these circumstances the following prescription will be found of 
service : 

R. — Acid, nitric, dil f^j. 

Tinct. cardamom, comp. . . . . f^vj. M. 

S. — Dessertspoonful in water four times a day. 

In old persons flatulence of the large bowel is frequently found, 
and is often associated with atony of the muscular coats of the gut. 
Under these circumstances the following prescriptions will be found 
of service : 

R. — Asafoetidse ....... gr. xl. 

Extract, nucis vomicae . . . . . gr. iv. 
Extract, physostigmatis . . . . gr. iij. 

Oleoresin. capsici Tltx. M. 

Ft. in pil. no. xx. S. — One pill three times a day, two hours after meals. 

Or, 

R — Tinct. belladonnse f gij. . 

Tinct. physostigmatis . . . . . f gj. 
Spt. camphorse . . . . q. s. ad f^iij. M. 
S. — Teaspoonful two hours after meals, or whenever needed. 

Where intestinal indigestion results in lientery the treatment be- 
comes entirely changed, except in regard to the use of a predigested 
milk diet, and efforts must be made to increase the secretion of the 
glands of the intestinal wall. Often minute doses of mercury bichlor- 
ide or podophyllin may do this, -^ to -fa grain of the first or second, 
respectively. More commonly, however, the mixture of nitric acid, 
given above, will be the proper treatment, or, perhaps, the following, 
if the liver is found to be torpid : 

R. — Acid, nitro-hydrochlor. (not dil.) . fgss vel f zj'. 

Infus. gentianae comp. . . . q. s. ad fjvj. M. 
S. — Dessertspoonful every four hours, or after meals, in water. 



INFLUENZA. 

The disease known as influenza influences various individuals so 
differently and presents so many symptoms associated with functional 
disorder of various organs in the body, that it is almost impossible to 
do more than consider the remedies which are to be employed in the 
treatment of the more frequent or more immediate manifestations or 



INFLUENZA. 523 

complications. Greater in importance than the employment of drugs 
must be regarded continuous rest, and stimulants are in many cases 
absolutely essential. 

In those cases in which the disease is ushered in by a severe chill, 
accompanied by violent pains in the back, if the patient is seen early 
enough, it may be necessary to employ remedies for the relief of the 
rigor, with the double purpose of improving the patient's general con- 
dition and preventing internal congestion of vital organs. In the 
majority of instances, however, the patient will not be seen during 
this period of the disease, but during the febrile stage, which succeeds 
that just mentioned. Under these circumstances the author does not 
believe that it is well for the physician to resort to any of the remedies 
which have been so largely used during the last few years, and which 
are known as the " antipyretics," or the derivatives of coal-tar. Al- 
though originally introduced for the purpose of reducing febrile tem- 
peratures, practical experience has taught us that their sphere of action 
is very limited under these circumstances, and the author almost 
never gives antipyrine, phenacetine, or acetanilide with the object of 
reducing fever. Although he does not believe that these remedies are 
to be used for the reduction of temperature, he has certainly seen very 
marked relief follow their employment with the object of relieving the 
severe pain which occurs in the back, limbs, or head. Small doses 
are usually sufficient to at least reduce the suffering, if not to remove 
it entirely, but as cardiac complications are by no means unusual, large 
doses are contra-indicated in most persons. The author prefers to 
allow the patient to suffer from a moderate degree of pain rather than 
from the dangers incident to the administration of doses large enough 
to entirely relieve it, because in his experience these doses have to be 
very large if they are to be entirely competent as analgesics. 

If any of the coal-tar products are used either for the relief of 
fever or of pain, phenacetine and antipyrine should be chosen. 
Experiments made in America and in Germany on animals have 
proved that phenacetine is far less toxic in its relations to the heart 
than is antipyrine or acetanilide, and while it has in a number of 
instances seemed more inclined to produce cyanosis in man than either 
of the other drugs, this cyanosis rarely, if ever, has been associated 
with any other dangerous symptoms. Indeed, it is quite extraordi- 
nary the amount of cyanosis which phenacetine may produce without 
the respiration becoming greatly disordered, very much less cyanosis, 
when caused by acetanilide or antipyrine, being accompanied by much 
more alarming symptoms. A very favorite combination with practi- 
tioners who have had a large experience is one of salol and phenace- 
tine. The action of the phenacetine in relieving the pain and in 
reducing the fever seems to point to it as a rational remedy, but the 
exact influence of salol under these circumstances is not so clear. 
Composed, as it is, of 60 per cent, of salicylic acid and 40 per cent, of 
carbolic acid, it seems to possess a therapeutical power different from 
that possessed by either of. these two constituents alone, for neither 
carbolic acid nor salicylic acid have much power in the relief of pain 



524 DISEASES. 

when used alone, unless, as in the case of carbolic acid, they are 
applied directly to the part affected. Perhaps the condition of pain 
in the lumbar and other muscles during the attack of influenza is in 
some unknown way associated with the condition which we have 
called " rheumatism/ 7 and in which salicylic acid does good in an 
unknown manner. Salicylic acid alone might be equally useful if it 
were dissolved in the intestine and did not irritate the stomach. 

On seeing a case of influenza during the first few hours of the 
attack, the author resorts to those remedies which have been in use by 
the profession for many years, and, so far as he can learn, it is the 
custom of other members of the profession to give a mixture composed 
of tincture of aconite, spirit of nitrous ether, and a solution of citrate 
of potassium in preference to any other medicine at this time. This 
mixture possesses the advantage of increasing the action of the skin 
and kidneys, and of reducing the temperature, of quieting the circula- 
tion, and of being readily taken by the patient without danger of dis- 
ordering the stomach at this time or later on, which is important, as 
this organ is apt to become irritable. As a general rule, citrate of 
potassium is given in too small doses, and, unless there are reasons to 
the contrary, it should be given in the dose of 15 to 20 grains three 
times a day. 

If the fever becomes excessive, so that there is danger of the patient 
suffering from a true hyperpyrexia, it is better to resort to cold 
bathing instead of the autipyretics first spoken of. It is true that 
the patients themselves and the friends of the patients will sometimes 
protest against what they deem an heroic measure, but the author is 
satisfied that if the cold is used in the proper manner it is devoid of 
danger to the patient. The majority of physicians do not seem to 
carry out the treatment of Brand and Leibermeister as it is carried 
out by its originators. Most of them forego the very important por- 
tion of the treatment, which consists in frictions designed to bring the 
heated blood to the surface, and the author has again and again seen 
physicians apply cold either by means of a wet sheet, by sponging, or 
a cold bath without using any measures which are directed against 
internal congestion. (See Cold.) 

Hyperpyrexia in influenza does not seem to possess the same dangers 
that it does in the course of some other diseases. In the first place, as 
a general rule, the course of the disease is a brief one, and although 
it may leave the patient weak and exhausted, the duration of the 
malady does not extend beyond a few days. Clinical experience and 
physiological study have proved that it is not the temperature of 105° 
or 106° F. which is distinctly dangerous, but the continuation of this 
temperature for many hours, which is harmful. Similarly, a patient 
ill from typhoid fever, having a temperature of 103°, for many days 
suffers very much more than does a patient who is suffering from 
pneumonia, and who may have for forty-eight hours a temperature of 
104.5° or 105°. For these very reasons a temperature of 104.5° 
or 105° is not particularly alarming in the condition which we are 
considering, unless they are symptoms pointing to the fact that the 



INFLUENZA. 525 

patient is being injured by an excessive temperature, as may be indi- 
cated by somnolence and an exceedingly dry skin, as well as cerebral 
symptoms. Of course, if renal trouble, associated with cardiac disease, 
comes on at this time, methods for the reduction of the temperature 
must be resorted to. The point to be strongly emphasized is that the 
mere existence of high temperature is not to be regarded as a point to 
which great attention must be given by the use of drugs. 

It seems to be the general consensus of opinion, both in this country 
and in England, that any measures of a depleting character are dis- 
tinctly harmful in influenza, even at its earliest stages, and we would 
naturally expect that this would be the conclusion arrived at by physi- 
cians who treat their patients rationally. Although influenza is a 
short-lived disease, there is probably no malady in which the patient 
goes on into a condition of profound depression, or even exhaustion, 
as in this one. The abstraction of blood from a vein, or by the use 
of cups, should not be resorted to. It may increase the danger from 
exhaustion before the system has a chance to recover from the simul- 
taneous appearance of the attack and the therapeutic measures of the 
physician. 

As the case of influenza progresses, a condition of marked depres- 
sion, or even collapse, very frequently develops. The expression of 
anxiety on the patient's face is to a physician, who is accustomed to 
see it in other diseases, a most alarming symptom, and it is not until 
one has seen it repeatedly in influenza that he is able to give it its 
exact value. Associated with this condition, the skin is frequently 
covered with a profuse perspiration and the pulse is very apt to be 
very rapid, running, feeble, and easily compressed. At first glance 
the old saying, that " we treat the symptoms as they arise/ 7 would 
seem to cover to a very large extent the indications which are present 
at this period ; yet the author's experience, which may differ from that 
of some of his readers, is that the cardiac stimulant which we are 
most frequently accustomed to use — namely, digitalis — does not seem 
to take hold of the circulatory apparatus and to act upon it in the 
manner which is desired. It may be that the pressing symptoms have 
made us more anxious and impatient as to the use of my medicament, 
and that we have not had the patience to wait and allow such a slowly- 
acting remedy as digitalis to take effect. Be this as it may, we have 
come to regard strychnine as infinitely preferable to foxglove when 
these symptoms appear ; and we have been able to prevent their appear- 
ance, or at any rate to modify them to a very great extent, by using 
strychnine in full doses from the first portion of the stage of depression. 
We believe that, as a general rule, strychnine is given in very much 
smaller doses than safety requires, and that in many instances it fails 
to act because the doses are too small to struggle with the profound 
condition of exhaustion which is present. In an adult we can see no 
reason why -^V of a grain may not be given twice or even three or 
four times in twenty-four hours, and in some cases we have given it 
every four hours without producing any of the symptoms of an over- 



526 DISEASES. 

dose of strychnine. Divided doses are better than a few very large 
ones. 

The author knows of no better illustration of the fact that in some 
conditions we are to give drugs for effect rather than according to cus- 
tomary dose than the employment of strychnine in influenza, and the 
physician who is timorous in the presence of this frequent complica- 
tion, depression, certainly increases the patient's danger. As with 
everything else, the drug should be carefully watched, and at the first 
sign of muscular twitching, or stiffness at the back of the neck, its 
administration should be cut down or discontinued. In many in- 
stances where the collapse comes on suddenly, the strychnine should 
be administered hypodermically and followed by full doses by the 
mouth, in order to keep up the full effect exercised by the drug upon 
the nervous and circulatory system. In some cases it will be found 
that the blood paths seem to be so relaxed and atonic that the strych- 
nine is unable to produce a sufficient vascular effect to bring the 
patient out of his difficulties, and under these circumstances very good 
results follow the combination of belladonna with strychnine ; the 
belladonna being, as we well know, a poweriul vasomotor stimulant 
under such circumstances. It also should be given in full doses for 
effect. As the acute stage of depression passes off the belladonna 
should be stopped and the strychnine continued alone through conva- 
lescence. 

Alcohol has not seemed to be of much value during the active 
period of the disease; In milk-punches and eggnogs it is, of course, 
useful during convalescence. If delirium comes on it has not seemed 
to be a symptom of very serious character either for immediate re- 
sults or in influencing the prognosis as to the ultimate recovery of 
the case, and in cases of pneumonia, complicating grippe, in which 
delirium was the prominent symptom, it appears that delirium is 
not to be regarded in the same light as similar manifestations compli- 
cating ordinary pneumonia or other diseases. The delirium may be 
either talkative or muttering, but does not in the majority of cases 
require treatment, passing away with the fever and rarely extending 
into the stage of exhaustion. 

For the irritative cough, steam inhalations, laden in the first stage 
with benzoin or other innocuous and sedative substances, seem particu- 
larly useful. For the bronchitis, which is often present, it is gener- 
ally sufficient to administer the ordinary mixtures containing ipecac, 
potassium citrate, in the earliest stages, and to follow them by chloride 
of ammonium and cubebs in the later stages. The author does not 
think that the compound licorice mixture containing antimony should 
be given in the second stage of influenza. A complication too apt to 
occur at this time is oedema of the lung or a widespread bronchitis 
with a profound exudation which bids fair to drown the patient in 
his own secretions. Antimony is not only a substance depressing 
to the circulatory and respiratory systems, but aids very materially 
in causing the peculiar variety of secretion which has just been 
spoken of. 



INSOMNIA. 527 

It may be necessary to use bromides if the cough is excessive, or to 
replace them by codeine, or very small doses of morphine. In many 
cases still better results will be obtained by a good preparation of 
cannabis indica, which may be pushed until it relieves the cough, 
without in any way endangering the patient's life, a safety which 
cannot be obtained by the employment of any other of the drugs 
named. 

If sleeplessness is so pressing a symptom as to require attention, 
the bromides may be given, but it will be generally found that the 
insomnia comes after the attack rather than during it, or in any event 
it will not require attention until the patient is convalescent. Under 
these circumstances chloral or chloralamide, or even sulphonal, may 
be administered, care being taken, of course, in the case of chloral 
that the cardiac apparatus is in good condition, and in the case of sul- 
phonal that it is administered in a powdered form, or dissolved in 
hot water and given four or five hours before the time at which sleep 
is desired. 

For the vertigo and dizziness which are sometimes bitterly com- 
plained of by the patient, either during or after the attack, small doses 
of bromide with ergot or cannabis indica have seemed particularly 
valuable, probably because they exercise some effect upon the blood- 
vessels of the brain or its membranes, or perhaps upon the bloodves- 
sels of the ear. Certain it is that in those cases of tinnitus not asso- 
ciated with organic change in the aural canals, bromides and ergot 
do more toward relieving them than any other medication. 

In the constipation which is sometimes present in the early stages 
of influenza it is generally advisable to administer either castor oil, or 
in other cases half an ounce of the sulphate of magnesium, or for 
more fastidious patients the citrate of magnesium. A full purgative 
effect of any of these salines seems to lessen the fever when it unloads 
the bowels. Care should be taken that the dose of the purgative is 
not excessively large, as it will weaken the patient as much as would 
bleeding. For the constipation following the attack, probably no 
drug is as efficient as cascara sagrada, combined perhaps with aloin. 
If diarrhoea supplants the constipation, the ordinary astringents, such 
as aromatic sulphuric acid or hsematoxylon, will be found sufficiently 
active. 

INSOMNIA. 

Insomnia is a condition characteristic of almost every disease in 
some of its stages, and arises from such a host of causes that the 
physician may not be able to discover any one of them for days after 
the patient is first seen. As a general rule, a patient consulting a 
physician with this symptom expects a prescription to be given at 
once and the cause found out afterward, or, in other instances, wil- 
fully defeats all the efforts of the practitioner for one reason or another, 
but desires relief although he may not choose to aid in its attainment. 
Under these circumstances the physician may safely employ certain 



528 DISEASES. 

drugs according to the information that he may have concerning the 
patient's state. 

One of the most common remedies is chloral given in the following 
manner : 

R. — Chloralis giij. 

Syr. simplicis f.^iv. 

Aquse cinnamomi . . . . q. s. ad f^iij. M. 
S. — Dessertspoonful at night. 

Or, 

R .—Butyl chloral -hydrat gj. M. 

Ft. in pil. no. xii. S. — One, two, or three pills at night, as needed. 

Where, for any reason, as the presence of a weak heart, chloral is 
contra-indicated, resort may be had to the bromide of potassium or 
sodium, and if the patient is a female, these drugs should always 
be accompanied by a small dose of arsenic, generally in the form of 
Fowler's solution, 1 to 3 drops three times a day, in order to avoid 
all danger of the production of acne. The following prescription is 
useful : 

R — Potassii bromid ^ij. 

Liq. potassii arsenit f.^ss. 

Aquse cinnamomi . . . q. s. ad f^vj. M. 

S.— One to two dessertspoonfuls at night. 

In many cases larger amounts of the bromide will be needed. 

Where the sleeplessness is due to pain, chloral is of little value and 
bromides are worth but little more. Under these circumstances, by 
resorting to what is known as the " crossed action of drugs," we can 
often obtain a very good effect. Thus morphine and chloral both act 
on the brain to produce sleep, or, in other words, their action is here 
crossed, for one relieves pain and the other does not; one kills by 
failure of the heart in overdose, the other by respiratory failure : 
as a consequence, large doses of neither can be given alone. The 
following is, therefore, a useful combination either where one drug 
fails, or when dangerously large doses of either one alone have to be 
used to obtain the desired result : 

R . — Morphinse sulphatis gr. iv. 

Chloralis . ,^ij. 

Aquae q. s. ad f ^ iv. M. 

S. — Dessertspoonful at night. 

In cases where insomnia is due to mania, hyoscine is said to be very 
useful, given in the dose of y^-Q to -^q grain by the mouth, or Tr ^ to 
TiTo by the hypodermic needle. Owing to its tastelessness the powder 
may be put on the tongue, and it is best to order a little sugar of milk 
or white sugar (1 grain) to every small dose of hyoscine, in order to 
give it bulk. 

Where insomnia follows mental effort, avoidance of all cerebral 
activity should be insisted upon during the evening, and if the feet 
are cold on going to bed, sleep should be induced by a hot foot-bath or 
the use of a hot- water bag at the feet and cold to the head. 



INTERMITTENT FEVER. 529 

During the last few years a very large number of remedies have 
been introduced as hypnotics, such as somnal, paraldehyde, chloral- 
amide, sulphonal, amylene hydrate, hypnal, and others. None of 
them are comparable in therapeutic activity with the older remedies, 
although sulphonal and chloralamide seem to be the best of the lot. 
The dose of sulphonal is 10 to 20 grains in powder, but as it is large 
in bulk and hard to swallow it should be used in a prescription made 
up as follows : 

R. — Sulphonal. . gr. xxx. 

Syrupi simplicis f gij. 

Mucilaginis acacise . . . . . f ^ij. 

Aquae destillat q.s.ad f^j. M. 

S. — Half to all of this at one dose, as may be needed. 

In other instances sulphonal may be dissolved in very hot water 
and the solution swallowed before it cools sufficiently to permit pre- 
cipitation. 

Chloralamide may be used in the dose of 15 to 60 grains dissolved 
in wine or given in capsule. Paraldehyde is given in the dose of 20 
to 60 minims. As it is disagreeable in odor and taste, it must be 
given in capsule, and it is very apt to disorder the stomach. 

The dose of amylene hydrate is the same as that of paraldehyde. 
It is a liquid, and, like the rest of the drugs named with the exception 
of hypnal, has no effect in insomnia from pain. 

Somnal is used in the dose of 10 to 40 minims with liquorice and 
water, and possesses considerable pow r er. 

In the treatment of insomnia it should be remembered that drugs 
should be used which, if possible, will quiet the part of the brain 
w 7 hich is most active. Thus, if the patient tosses much, we use bro- 
mides and chloral as motor depressants. If sensation is active 
bromides and the hot-pack are used to act as sensory quietants. In 
other cases horseback exercise taken late in the afternoon does good, 
particularly if the patient follows a sedentary life. Many persons 
who are usually sleepless will obtain a refreshing slumber by taking a 
very light and easily digested meal just before retiring for the night 
or by eating a cracker or drinking a glass of milk when they awake 
during the night. 

INTERMITTENT FEVER. 

In all forms of intermittent fever, whether the attacks are diurnal, 
quotidian, tertian, or quartan, the best remedy for their prevention is 
quinine, which should, under these circumstances, be given about two 
or three hours before the attack is expected, so as to be absorbed and 
physiologically active when the paroxysm is due. This precaution 
is often overlooked, and the dose ordered at the time of the expected 
attack, with failure as a result. Not only should sufficient time elapse 
for absorption, but the fact should be remembered that the chill often 
begins an hour earlier each day, and will be in full sway before the 
quinine can stop it, if the drug be not administered at the proper time. 

34 



530 DISEASES. 

Experience has proved that quinine never acts as favorably if consti- 
pation is present as when the bowels are lax, and hepatic activity 
seems particularly necessary for its full effect. To obtain the full 
influence of the drug it should be preceded, by some four or five 
hours, by ^ to J grain of calomel every fifteen minutes until a grain 
is taken, or by a dose of podophyllin amounting to ^ to J- grain. If 
podophyllin is used, a louger time should be allowed before the anti- 
periodic is given, because of the slow action of this purgative, and if 
the patient has been rendered unusually insensitive to purgatives, 
larger doses of both the remedies named must be used ; particularly 
is this true in the South. 

The dose of quinine varies with the exigencies of the case, which in 
turn generally depend upon the region in which the patient lives or 
has lived. Ten to fifteen grains in one dose are generally sufficient in 
the eastern and northern States, but as much as twenty to forty-five 
or even sixty grains may be required in the southern parts of the 
United States and elsewhere. When these very large doses are em- 
ployed, the drug should be given partly hypodermically and partly by 
the rectum in suppository, or in solution, as well as by the stomach, as 
this viscus will rarely withstand 60 grains of quinine without irrita- 
tion. (For the best salts for hypodermic use, see article on Cinchona, 
page 144.) If the stomach is irritable, resort to these means of 
entrance into the body are absolutely necessary and must be entirely 
relied on. 

In cases where the attacks are several days apart, small doses of qui- 
nine of from 3 to 6 grains are to be taken daily between the paroxysms, 
or, what is better, arsenic may be given in moderate dose for its anti- 
periodic influence during the intermission. In this manner the quinine 
acts with full force when most needed. 

Having considered the prophylaxis of a chill, let us turn to the 
treatment of the attack itself. It must be remembered that the 
greater part of the harmful eifect of the malarial poison is exerted at 
this time by the internal congestions and engorgement of the abdom- 
inal and thoracic organs. The physician should, therefore, try to pre- 
vent, as far as possible, too great a rigor, and if stasis results from the 
chill, overcome it, not by depletants, unless the case is very sthenic, 
but by stimulants, such as digitalis, which will drive out the blood 
from the congested area. 

If a full meal has just been eaten, the stomach should be emptied by 
an emetic dose of ipecac, 2 drachms of the powdered drug to an adult, 
or by 20 grains of sulphate of zinc. It is about useless to give quinine 
at this time, as absorption from the stomach and subcutaneous tissues 
is almost entirely absent. Alcoholic stimulants are not to be employed, 
as clinical experience seems to indicate that they act unfavorably. 

If the chill is severe enough to endanger the patient's life, measures 
must be used to control it. Chloroform may be inhaled and imme- 
diately preceded by laudanum by the bowel or mouth. If the lauda- 
num is given by the mouth, a little ether or chloroform may be added 
to the dose of the opiate. The opium may be used hypodermically in 



IRITIS. 531 

the form of morphine, in the dose of -J- of a grain combined ,wi£h -fa of 
a grain of atropine. 

In the fevered stage little can be done, except to give the patient 
comfort by cool drinks and cool sponging, or if the fever becomes 
excessive by the use of antipyrine or the ice-pack. The latter has 
seldom to be used, as the fever is generally too fugitive to need such 
measures. 

The sweating stage needs no particular treatment, unless exhaustion 
is caused by it, when stimulants may be cautiously used as needed, and 
large draughts of water at ordinary temperatures swallowed. 

Many measures have been resorted to to put off a malarial attack, 
the chief of which is the use of ether or chloroform anesthetization at 
the time of the expected paroxysm, of nitrite of amyl or of the nitrite 
of potassium or sodium in 10-grain dose for the same purpose. Where 
the " chill habit " exists and depends largely upon nervousness it has 
been broken by misplacing the hands of the clock, and so getting the 
patient past the time for his attacks without his knowledge. 

It should be remembered that the use of quinine in malarial fevers 
is no longer based on empiricism, but upon the fact that the drug 
exerts a peculiarly lethal influence over the cause of the disease, the Plas- 
modium malarioe of Marchiafava and Celli, or, as it is sometimes called, 
the malarial germ of Laveran or the hsematozoon of malaria. 



IRITIS. 

Iritis, or inflammation of the iris, as usually encountered is caused 
either by syphilis, rheumatism, or gout. It may also be traumatic ; 
less frequent causes are gonorrhoea, diabetes, malaria, and tuberculosis, 
Metastatic iritis occurs in pyemia, relapsing fever, etc. The most 
marked symptoms are severe brow pain ; fine ciliary injection ; dis- 
coloration of the iris and immobility of the pupil, due to the forma- 
tion of adhesions between the iris and the capsule of the lens. The 
most important local remedy is atropine, to be used every two hours 
according to circumstances. If for any reason this is not tolerated, 
duboisine or daturine may be substituted. Cocaine increases the 
mydriatic power of atropine. 

Pain may be relieved by leeches to the temple and the use of dry 
heat externally (cotton batting heated over a register will suffice) or 
hot fomentations — water, chamomile infusion, or laurel-water (1 to 15). 

In traumatic iritis iced compresses are suitable in the early stages, 
but not in the later periods, and not in any other form of iritis. Great 
care must be taken not to mistake iritis for conjunctivitis, on the one 
hand, and glaucoma for iritis, on the other ; delayed use of atropine 
and the employment of astringents on account of the former error, or 
the instillation of. atropine because of the latter, would constitute seri- 
ous therapeutical blunders. In serous iritis, or that variety in which 
there is a hypersecretion of the aqueous humor, which becomes turbid, 
and a precipitate of dark spots occurs upon the membrane of Descemet, 



532 DISEASES. 

atropine must be cautiously instilled, owing to the tendency to in- 
creased tension. If this occurs, paracentesis of the cornea may be 
needed, and pilocarpine should be given internally, if the vitreous 
becomes opaque. 

In true syphilitic iritis mercury must be pushed to the point of 
tolerance, but it is not necessary to salivate the patient. Any form of 
mercury usually employed in secondary syphilis may be used — calomel, 
blue mass, or protiodide of mercury — but the most efficacious method 
is by inunction ; this is preferable even to hypodermic medication, in 
the opinion of many authors. After the mercurial impression has 
been made, and the pupil is well dilated, potassium iodide, either 
alone or in combination with bichloride of mercury, is indicated. 

In plastic iritis, appearing six to eight months after the disappear- 
ance of the secondary symptoms, this latter treatment, without the 
previous use of mercury, has been recommended. CarmichaePs plan, 
consisting in the administration of drachm doses of turpentine, in addi- 
tion to which the potassium iodide may be given, receives the endorsement 
of some surgeons, and is useful in serous iritis. 

Rheumatic iritis calls for salicylic acid, oil of gaultheria, and, later, 
potassium iodide ; in the chronic types of the affection Zollicoffer's 
mixture is an excellent remedy. Potassium iodide should be admin- 
istered in gonorrhoeal iritis, and relief occasionally follows a pilocar- 
pine sweat. In all forms of iritis the treatment of the constitutional 
disorder which has occasioned the local inflammation is necessary, and 
if the iritis becomes purulent surgical interference is usually required. 
In any variety of iritis the intense pain should be alleviated with 
morphine or other anodyne sufficiently active to secure sleep. During 
the course of the disease saline laxatives may be administered,, and 
after the subsidence and cessation of the specific treatment, a course of 
iron tonics is an excellent routine practice. 



KERATITIS. 

Keratitis is the name applied to the various types of inflammation 
of the cornea. If this inflammation is associated with a breach in the 
continuity of the corneal surface it is termed corneal ulcer, and four 
characteristic symptoms supply the indications for local treatment : 
1, photophobia, or dread of light ; 2, blepharospasm, or spasmodic 
contraction of the orbicularis muscle ; 3, congestion of the bloodves- 
sels ; 4, pain ; while any existing dyscrasia or constitutional condition 
upon which the local disease may depend requires general medication. 

Interstitial Keratitis. 

Interstitial keratitis is that form of chronic diffuse inflammation 
of the cornea characterized by ciliary congestion and a ground-glass 
appearance of this membrane, most common between the ages of five 
and fifteen years, and, in the vast majority of cases, the result of 



KERATITIS. 533 

inherited syphilis. No local measure is sufficient, anti-syphilitic treat- 
ment being of paramount importance. During the height of the ciliary 
congestion warm antiseptic lotions and atropine are indicated, the latter 
especially to prevent the tendency to iritis. Severe pain may be alle- 
viated by the use of a leech to the temple, if the subject be of sufficient 
age to justify the employment of local bleeding. 

Various other types of keratitis are described as the result of con- 
stitutional disturbances, such as gout (Hutchinson), malaria (Kipp, 
Van Milligen), or any condition of the system associated with great 
exhaustion, such as irregularities in the menstrual functions, certain 
forms of pulmonary disorders (true herpes of the cornea, Horner). 
The local management of these cases does not differ from that which 
has been described. The co-existing constitutional disturbances must 
be combated with suitable remedies. 

Phlyctenular Keratitis. 

Phlyctenular keratitis appears in the form of small, blister-like 
bodies, sometimes single, sometimes multiple, frequently situated 
directly at the corneo-scleral margin, which become yellow, break 
down, and leave an open ulcer (phlyctenular ulcer), to which runs a 
leash of injected bloodvessels. The disease is common in children ; 
often follows in the wake of the exanthemata, and is so frequently 
associated with a strumous diathesis that it was formerly called strumous 
ophthalmia. Congestion may be relieved by frequent irrigation with 
a warm boric acid solution. Pain and irritation call for the use of 
atropine drops (4 grains to the ounce), which should be continued until 
the ulcer is covered with regenerated epithelium, when the process of 
cicatrization may be hastened by the insertion daily into the conjunc- 
tival sac of a small quantity of yellow oxide of mercury salve, or 
dusting it with finely powdered calomel, provided the patient is not 
taking, at the same time, any form of iodine. During the whole treat- 
ment the eyes should be protected by dark glasses, and the subject 
permitted to go out into the open air. All local treatment will prove 
unsatisfactory unless associated with strict hygiene, carefully regulated 
diet, and constitutional measures — tonics and alteratives. 

If the photophobia becomes distressing in spite of the other treat- 
ment, it has been suggested that this may be relieved by the use of 
cocaine, a practice that by no means commends itself in corneal ulcera- 
tion, in spite of the temporary relief from the local anaesthesia. Relief 
of this symptom in many instances follows the use of a douche of cold 
water on the closed eyelids. 

Suppurating Keratitis. 

Suppurating keratitis, or that form of inflammation characterized 
by the formation of pus in the cornea, may be either diffuse, as, for 
example, a complication of purulent ophthalmia, or circumscribed, 
forming an abscess of the cornea. If the pus gathers in the bottom of 



534 DISEASES. 

the anterior chamber the condition is called hypopyon and the dis- 
ease hypopyon keratitis. These conditions require prompt treatment, 
namely, frequent application of hot compresses, which may be advan- 
tageously composed of slightly carbolized water, atropine drops, or, 
in the opinion of many, eserine (J to 2 grains to the ounce). If the 
abscess forms, the pus should be evacuated by a formal operation, 
either by dividing the anterior surface or by performing the operation 
after the manner of Saemisch. 

In addition to the types of disease which have been described we 
have the examples of sloughing or infective ulcers, which are seen 
under a variety of conditions, and often are directly traceable to an 
injury, being more common in elderly people. The tendency of all 
these ulcers is to spread, from whence one important variety has 
received the name serpiginous. The mild measures are antiseptic 
lotions, either boric acid or bichloride of mercury, iodoform, hot com- 
presses, and instillations of either atropine or eserine. Formerly 
atropine was almost exclusively used ; in recent years eserine has been 
much employed. It certainly has the power of limiting a sloughing 
process in the cornea. Threatened perforation may be averted by a 
pressure bandage. This is made by placing upon the eye a wad of 
antiseptic cotton, over which, in figure-of-eight turns, a flannel roller 
is applied. If, in spite of this, the process continues, the following 
measures have met with the greatest success : Touching the margin 
of the ulcer with a strong solution of nitrate of silver, 10 to 20 grains 
to the ounce, care being taken that the ulcer alone receives the appli- 
cation ; scraping the floor of the ulcer with a small curette or spud ; 
finally, and this is the best method, the use of the actual cautery. 
In every case of sloughing ulcer the lachrymal passages must be ex- 
plored for obstruction. 

SequelsB of Corneal Ulceration. 

After healing of a corneal ulcer the cicatrix consists of a more or 
less dense white spot in the cornea (macula). If these scars are thick 
and white they are irremediable by local medication, and require sur- 
gical interference for optical relief. If, however, they are diffuse, 
much good will follow systematic massage of the cornea, aided by the 
introduction of a small particle of yellow oxide of mercury salve. 
The massage is performed as follows : A piece of the salve the size 
of a split pea is introduced beneath the upper lid ; upon the closed 
lid a finger is placed, and regular motions made through the lid over 
the surface of the cornea, namely, vertical, lateral, aud radial motions, 
the sSance being completed by circular movements. The whole should 
last from one to three minutes. Alleman claims excellent results in 
dissipating corneal opacities by the use of electricity, by connecting a 
suitably prepared electrode with a battery, the cathode being placed 
directly on the previously anaesthetized cornea and the anode on the 
cheek. 



LARYNGITIS, ACUTE. 535 



LACHRYMAL ABSCESS. 

Lachrymal abscess results from suppuration in a chronically dis- 
teuded lachrymal sac, owing to the preseuce of obstruction in the nasal 
duct, and exists as a swelling under the skin at the inner canthus, 
pressure upon the surface causing an escape of pus through the canal- 
iculi. The treatment is practically confined to surgical interference 
— that is, division of the canaliculi and washing out the distended 
sac with antiseptic fluids, and restoring the patulency of the nasal 
duct by the use of probes as soon as the inflammatory symptoms have 
subsided, or if the skin over the seat of the abscess is thinned and 
rupture is threatened, by free puncture downward and outward. In 
purulent discharge from the lachrymo-nasal duct, solutions of blue 
pyoktanin (1 to 1000) injected through the passage, favorably modify 
the unhealthy secretions. Much comfort will ensue from the use of hot 
compresses over the inflamed area. These may be made in the ordi- 
nary way, or are still more efficacious if composed of a lead lotion, the 
ordinary lead-water and laudanum answering the purpose very well. 



LARYNGITIS, ACUTE. 

Acute laryngitis is an inflammation involving the mucous mem- 
brane of the larynx^ to which it is usually confined, although it 
sometimes assumes a phlegmonous form, in which the deeper struc- 
tures of the larynx are involved. It may in form be idiopathic or 
traumatic. 

The idiopathic form results from exposure to cold, from extension 
of inflammation from above or below, is a local expression of a con- 
stitutional disease, as in scarlet fever, diphtheria, or syphilis, or is an 
acute exacerbation of chronic laryngitis. 

If traumatic, it may be the result of the presence of foreign bodies, 
as fish-bones, pins, or may be due to operations upon the larynx. 

The symptoms of acute laryngitis are hoarseness of voice, pain in 
the throat, tickling cough, and difficult or painful deglutition. The 
cough is often annoying and out of proportion to the amount of ex- 
pectoration. It may be brazen or barking in character, but should 
there be much swelling is more likely to be smothered. These 
symptoms may be aggravated by dyspnoea. 

The attack may be ushered in by a chill, followed by fever, head- 
ache, pain in the back and limbs. 

Acute laryngitis may be strictly local, though, as a rule, the inflam- 
mation does not limit itself to the larynx, but extends into the 
pharynx, even reaching the tonsils. 

When the epiglottis becomes inflamed the pain is exquisite and is 
felt both in swallowing and in using the voice. Extension to the 
trachea gives sub-sternal pain, while pressure on the breast-bone 
excites coughing. 



536 DISEASES. 

Unless aborted, an attack lasts about a week or ten days, and may 
continue three weeks or more. 

A laryngoscopic examination gives us the only means of making 
a perfectly accurate diagnosis. The mucous membrane varies from 
bright red to purple, the shade dependiug on the severity of the 
inflammation present. 

If the inflammation is diffuse, all the parts are of the same color, 
the ventricular bands and arytenoids usually being the first to swell. 
The ventricular bands may overlap the cords. 

The inflammation may be circumscribed. The writer has seen 
instances in which the vocal cords alone escaped and remained per- 
fectly white. Sometimes only one side is affected, one cord alone 
being involved. Pyriform swelling of the same arytenoid generally 
occurs and strongly suggests incipient phthisis. The trachea when 
inflamed may be seen below the glottis, having a diffused red color, 
the rings being hidden by the swelling. 

With some, every attack of coryza ends in laryngitis ; or, as it is 
popularly expressed, the cold " goes down." 

Prompt measures will often abort an attack. 

During an acute attack the patient must be kept quiet, talking as 
little as possible, remembering that whispering is more injurious 
than vocalization. The diet should be bland and unirritating, but 
nutritious. 

At the outset, a hot mustard foot-bath and demulcent drinks 
should be administered, and small, repeated doses of calomel given 
and followed by a saline purge. Fever is to be combated by aconite 
combined with a diaphoretic. An opiate — as a Dover's powder — ■ 
may be required to relieve pain and give rest. Inhalations of steam 
charged with benzoin, camphor, or cubebs may be used. 

Locally, the best results follow the employment of alkaline or 
astringent sprays, followed by the insufflation of anodyne and astrin- 
gent powders into the larynx. 

Gargles are of very little use in laryngitis, better results being 
obtained from the use of lozenges slowly dissolved in the mouth. 
Excessive cough may be relieved by nervous sedatives, such as bro- 
mide of sodium or potassium combined with small doses of potassium 
cyanide. Opiates disorder the digestion, and should only be used 
when specially indicated. A very useful treatment is full doses of the 
bromides combined with rubbing the neck and chest with amber oil 
and sweet oil, half and half. 

During convalescence, tonics, fresh air, and change of climate are 
indicated. Attention to the state of the skin and the use of woollen 
underwear are advisable. 

Subacute Laryngitis. 

This form of laryngitis often occurs in debilitated subjects whose 
systems are not vigorous enough to carry on an acute inflammation, 
or have not sufficient recuperative power to throw off an attack rapidly. 



LARYNGITIS, SUBACUTE. 537 

It may also follow an acute attack when, from any cause, conva- 
lescence is retarded. 

Subacute laryngitis produces very little constitutional disturbance, 
and its symptoms are, for the most part, the symptoms of acute laryn- 
gitis, excepting that they are all of a milder type. Pain, soreness, 
and a burning sensation are referred to the region of the larynx. The 
voice is husky, and efforts at conversation excite paroxysms of cough- 
ing. The expectoration, at first only glairy mucus, becomes yellow 
and more abundant as the disease progresses. Laryngoscopic exam- 
ination shows that the mucous membranes are redder than normal, but 
not of the livid shade seen in the acute form. Mouth-breathing, due 
to occlusion of one or both nostrils, should be looked upon, when 
present, as a predisposing cause. 

The treatment adopted in the acute form is usually sufficient to 
produce a cure. The inhalation of steam charged with an ethereal oil 
or gum resin relieves the engorged vessels and stimulates the mucous 
membrane to healthier action. Compound tincture of benzoin, 30 or 
40 drops in a cupful of hot water, has done the writer good service. 
An extemporaneous inhaler is made by covering a cup with an in- 
verted funnel. The benzoin will be volatilized by the heat, and the 
medicated steam is readily inhaled from the small end of the funnel. 
The vapor should be drawn in through the mouth gently and firmly, 
the breath being held a second and then exhaled through the nose, 
and the inhalation continued until the water cools, this process being 
repeated at intervals during the day. If the secretion is thick and 
tenacious, better results will follow the addition of a few drops of tere- 
bene or oil of eucalyptus to the benzoin. 

As this hot inhalation often induces perspiration, it may be well 
to caution the patient against exposure in the open air immediately 
after using it. This form of inhaler has the advantage of being 
simple and cheap, as well as effective, and may be constructed at a 
moment's notice in any kitchen. An inhaler devised by Seiler meets 
the requirements, and, being made of tin, is not injured by hot water. 
It consists of a tin cup having a lid shaped like an inverted funnel, 
the end of the funnel terminating in a rubber mouth-piece. A tin 
tube runs through the lid and reaches below the surface of the liquid 
in the cup. Suction upon the mouth-piece causes the air to be drawn 
down through the tube and bubble up through the liquid. By this 
means the vapor is more strongly charged with the preparation used. 

In addition to benzoin we may use camphor, and fluid extract of 
cubebs or tar, as inhalations which are stimulating or sedative to 
the mucous membranes in different degrees. Astringent sprays of 
sulphate of zinc, ferric alum, tannic acid, or a weak solution of 
bichloride of mercury are useful in the hands of a physician. 

Even better results are obtained by the insufflation of astringent 
powders into the larynx, all adherent secretions having first been 
removed by an alkaline or antiseptic spray. 

This method is more accurate than that of astringent sprays, but 
the insufflation of powders into the larynx with any degree of con- 



538 DISEASES. 

fidence presupposes considerable proficiency in the use of the laryngo- 
scope, a description of the methods of which would carry us beyond 
the limits of a work of this nature. 

Among remedies suitable for insufflation are : Sulphate of zinc, 
mixed with an equal part of sugar of milk or other inert substance. 
(The powder must be so fine that no grit is felt when rubbed between 
the fingers.) Tannic acid reduced to one-fourth or one-fifth, com- 
bined with iodoform, is useful on abraded or ulcerated surfaces. To 
this mixture subnitrate or subcarbonate of bismuth may be added 
when indicated, and morphine also, for the relief of pain. Acetate 
of lead in proportion of 10 to 20 grains to J ounce, combined with 
a little acetate of morphine, gives us what may be called a solid 
a lead-water and laudanum." 

Nasal catarrh, if present, must be treated, otherwise the laryngitis 
will probably not be permanently cured. 

To prevent a return of the development of chronic laryngitis, the 
treatment should consist of tonics, such as iron, quinine, strychnine, 
and cod-liver oil, together with a generous diet and exercise in the 
fresh air. Owing to the intimate relationship between the skin and 
the mucous membranes of the nose and throat, the use'of woollen 
underwear is important. Friction to the skin and Turkish baths, 
especially when a gouty or rheumatic ailment exists, may give good 
results. 

Should any permanent laryngeal thickening remain, potassium 
iodide, with or without arsenic, continued for a long time in very 
small doses, or one of the lithia waters, may be of service. 

Chronic Laryngitis. 

This form of laryngitis, like the subacute, is divided into the simple 
catarrhal or idiopathic, and the traumatic. The catarrhal form also 
includes those varieties in which a constitutional vice occurs, as 
phthisical, gouty, or syphilitic laryngitis. 

Chronic laryngitis may develop insidiously, or it may be the direct 
result of an acute or subacute attack. 

In a state of ordinary health, an attack of acute laryngitis runs a 
course of from one to two weeks, terminating in recovery. 

When from any cause the vitality is reduced, convalescence may 
be retarded, and we have what is kuown as subacute laryngitis, a 
lower grade of inflammation than the acute form, but still tending to 
recover under favorable conditions. A renewal of the attack at this 
stage may carry the patient beyond the line where Nature unaided is 
able to assert herself, and chronic laryngitis results. 

A lowered state of health is a predisposing cause, particularly wdien 
there is a lowered nervous tone. 

Overwork, business reverses, or severe mental strain ; a sedentary 
life, continued exposure to impure air, sewer gas, fumes from chem- 
icals, or the dust and fibres floating in the air of cotton and woollen 
mills — all act as predisposing or exciting causes of chronic laryngitis. 



CHRONIC. 539 

Loss of sleep, over-indulgence, and excesses tend to produce the same 
result. In regard to the use of tobacco, cigarette smoking is more 
injurious than either the pipe or cigar, for the reason that the cigar- 
ette smoke is inhaled, and the irritating products resulting from the 
destructive distillation of the woody fibre are drawn directly into the 
larynx. 

Chronic laryngitis is essentially a disease of civilized life. One of 
its most common sources is found in mouth-breathing and its conse- 
quences. 

The nose is so constructed that a large surface of mucous membrane, 
warm and moist, comes into contact with the inspired air, imparting 
to it its warmth and moisture, w T hile particles floating in the air adhere 
to the moist surface and are discharged with the flow of mucus which 
they excite. 

In mouth-breathing no such preparation of the air occurs, and the 
delicate mucous membrane of the larynx, being subjected to this 
constant source of irritation, is kept in a congested condition. 

The symptoms of ordinary chronic laryngitis are hoarseness, diy- 
ness of the throat, tickling sensations, vague feelings of discomfort, a 
sense of constriction about the throat, and a dry, hacking cough. The 
expectoration is usually scanty and raised with difficulty. A profuse 
discharge from the vault of the pharynx, removed by hawking, indi- 
cates more or less naso-pharyngeal catarrh. 

The mucous membrane in simple cases, as seen by the laryngoscope, 
is redder than normal. The ventricular bands may be thickened until 
they nearly overlap the cords. The vocal cords vary in color from a 
muddy tinge to a deep livid red. The inflammation sometimes occurs 
in livid spots. 

Iujection of the vocal cords may be marked, showing twigs of 
dilated bloodvessels running longitudinally. 

As the result of irritation occasionally a minute white fibrous swell- 
ing develops on the free edge of a vocal cord, or two may form directly 
opposite each other, interfering with the proper approximation of the 
cords. They are usually mere points, and the writer has only seen 
them occur in the throats of singers. They gradually become smaller 
under astringent applications and attention to hygiene. 

Finally, fissures or abrasions may occur in the larynx in chronic 
laryngitis, the common location being the inter-arytenoid space. A 
small laryngeal fissure is not always easily recognized. 

The mucous membrane at that point is usually darker than the 
surrounding tissue, and may be bathed in a muco-purulent secretion. 
In the morning, after considerable coughing, a small pellet, resem- 
bling boiled sago, which has formed during the night, may be coughed 
from this spot. 

When a fissure of this nature granulates it may give rise to many 
of the symptoms of laryngeal phthisis, a diagnosis which the laryngo- 
scope can alone clear up. 

The physician must strike at the root of the trouble by finding the 
cause and removing it. If due to a faulty use of the voice, either in 



540 DISEASES. 

speaking or singing, proper training in its management and care will 
be productive of decided benefit. 

As far as possible, all sources of irritation should be removed. 
Relieve nasal obstruction, enlarged tonsils, or anything that prevents 
the free circulation of air through the nose ; for we cannot look for a 
cure while mouth-breathing continues. 

Complete rest of the voice, with attention to the general health, 
will greatly relieve the throat in most instances ; but, unfortunately, 
the trouble usually returns on resuming the use of the voice. In 
fact, it is not always advisable for one who must use his voice again 
to prolong the rest indefinitely, for a throat accustomed to heavy 
demands is liable to stiffen under prolonged disuse, the voice never 
quite regaining its old power and flexibility. 

After the laryngitis has made decided improvement, the judicious 
use of the voice has seemed to the writer, in some instances, to have 
favored resolution, and to have kept the muscles from degenerating. 

Very much depends on local treatment in the cure of chronic 
laryngitis, and some of the directions given for treating subacute 
laryngitis apply here equally well. 

After cleansing the mucous membrane of the larynx from secre- 
tions, the use of astringent sprays gives excellent results. 

The insufflation into the larynx of astringent powders, as sulphate 
of zinc reduced one-half; or tannic acid one-fourth or one-sixth, com- 
bined with boric acid, subnitrate of bismuth and sulphate of morphine, 
is useful in painful conditions. 

An excellent powder for protecting and covering raw or ulcerated 
surfaces is a modification of the formula known as " Ferrier's snuff: " 

R . — Morphinse sulph gr. v. 

Bismuthi subnit Sijss. 

Pulv. acacise gr. xzv. 

To this may be added iodoform, when this drug is indicated by the 
presence of ulcerations or abrasions. Indolent or granulating inter- 
arytenoid fissures should be touched with a strong solution of nitrate 
of silver applied by r a brush attached to a bent probe, or a little of 
the pure salt or the " mitigated " stick fused on the end of a silver 
applicator. 

This is by no means an easy operation to perform, as it is important 
to avoid touching any other part of the larynx, which would increase 
the spasm which is liable to occur. 

Stimulating vapor inhalations, such as compound tincture of benzoin, 
tar, or cubebs, used as was described under the heading of Subacute 
Laryngitis, give decided relief. Pleasant occupation in the open air or 
travel in a dry, bracing climate is useful. As a rule, the air at the 
seashore is too moist for chronic laryngeal troubles. 

Sufferers from chronic laryngitis should always wear woollen under- 
wear, and keep the skin and the secretions generally in a healthy 
condition. 



LEUCORRHCEA. 541 



LEUCORRHCEA. 

This is a condition — vulgarly known as the " whites ''—consisting in 
a hypersecretion from those glands which pour out their contents into 
the vagina or the cervical canal of the uterus, or even into the cavity 
of this organ. 

It is a state dependent upon many causes for its existence, the chief 
of which is a condition of the system when it is " run down " from any 
cause, with perverted functions of the glands or their surroundings. 
In some persons, who seem perfectly strong and well, it would appear 
to be due to an effort of the system to overcome plethora. The char- 
acter of the discharge varies with almost every case. In some instances 
it is thick and tenacious, in others so liquid as to trickle down the 
limbs in a stream and greatly soil the clothing. In most of the latter 
cases catarrh of the Fallopian tubes or ovarian irritation and tender- 
ness will be present. Where the secretion is very thick and tenacious 
it generally arises from the cervical canal, while that from disorder of 
the vaginal wall alone, independent of other morbid conditions, may 
be either thick or thin. 

The treatment of these forms of leucorrhcea may be divided into 
two parts : one, that directed to the remedying of the morbid process 
through the use of drugs by the mouth, the other by their employment 
locally. 

It is needless to state that in that form dependent upon excessive 
lactation, or other exhausting manner of life, tonics of an active char- 
acter are needed. As a general rule, anaemia will be present, and the 
following pill will be found of service : 

Be. — Acid, arseniosi gr. j. 

Ferri redacti gr- v. 

Quininse sulph 9J- M. 

Ft. in pil. no. xx. S. — One pill three times a day, after meals, for an adult. 

Or, 

R. — Tr. ferri chloridi f^j. 

Tr. cinchona? comp. . . . . . f.^ij. 

Tr. gentian, comp q. s. ad f Jiv. M. 

S. — Dessertspoonful three times a day, after meals. 1 

Sometimes small doses of the sulphate of iron are better for this 
purpose, owing to its astringent properties, and when any preparations 
of iron are used care must be taken that the bowels are kept active 
and that the stomach is not disordered. Associated with the use of 
these internal remedies should be a moderate amount of exercise and 
the avoidance of late hours and rich foods. 

The local applications which are of value in these states consist in 

1 In both these prescriptions the small amount of iron and arsenic given will prob- 
ably be noted, but this is done advisedly, as iron and arsenic do as much good to the 
blood in small as in large amounts, under most circumstances. (See Iron.) 



542 DISEASES. 

counter-irritation and vaginal injections or painting the mucous mem- 
brane of the parts from which the discharge comes with proper fluids. 
In the leucorrhoea dependent upon irritation of the ovaries with 
catarrh of the Fallopian tubes, the use of small blisters formed by the 
employment of cantharidal collodion or a cantharidal plaster over the 
groin on either side is often accompanied by good results. At the same 
time the vaginal surfaces surrounding the cervix uteri may be painted 
with a mixture of iodine, carbolic acid, and chloral, such as is used by 
Dr. Goodell, as follows : 

R . — Iodi resublimat. . . . . . . 3 iv. 

Acid, carbol. crystal. ") ^. 

Chloralis J ' ' " ' 5J * 

Bub the iodine and chloral in a glass mortar into a powder and add the carbolic 
acid. S. — Formula. To be used by the physician only. 

The following pill may also be employed : 

R . — Hydrarg. chlor. corros gr. h 

Ft in pil. no. xx. S. — One pill three times a day, after meals ; or a tablet 
triturate may be used instead of a pill. 

The remaining treatment of watery leucorrhoea consists in the use 
of astringent injections. A very cheap astringent injection is made 
by adding 1 ounce of powdered white oak bark to each pint of water, 
or tannic acid and glycerin in the proportion of 1 ounce to 2 quarts 
of warm water. Ringer recommends the following : 

R . — Sodii bicarbonatis gj. 

Tincturae belladonnse f ^ij. 

Aquae Oj. M. 

S. — Use as a vaginal wash. 

Where the discharge is foetid a solutiou of permanganate of potas- 
sium should be used as an injection in the strength of \ drachm to 1 
pint of water. In purulent vaginitis, specific or otherwise, the follow- 
ing injection is serviceable : 

R. — Creolin. fgssvelf^ij. 

Ext. hydrast. canaden. fl. . . ■ . . fgijss. 

Aquse f ^viij. M. 

S. — Add two tablespoonfuls to a pint of hot water and use as an injection. 

Sometimes a tampon thoroughly saturated with a powder of iodo- 
form and tannic acid, equal parts, and packed around a discharging 
uterine cervix, is of service. 

When using vaginal injections in females it is important to remem- 
ber that they should be in large quantities. Nothing is more antago- 
nistic to true asepsis than the usual manner in which these applica- 
tions are made. Generally a pint of the solution is placed in a basin 
over which the woman squats and by means of a syringe forces the 
liquid into the vagina as fast as it runs out, thereby filling the syringe 
joints with the dissolved secretions and returning to the vagina as soon 
as they flow away the impurities which have left it. The only proper 
way to give such an injection is to have the solution in one basin, to 



MANIA, ACUTE. 543 

the extent of 1 gallon, while the patient squats over a second basin 
into which the impure liquid may run. 

A very useful astringent injection may be made by ordering : 

R. — Zinc, sulphat f gj. 

Alumin. sulph. ....... f^j. 

Glycerini f^vj- M. 

S. — A tablespoonful to each quart of water. 

LID ABSCESSES. 

Lid abscesses are seen more frequently in children than adults, as 
the result of injury, the sequel of acute illness (epidemic influenza, pul 
monary catarrhs, fever, etc.), or from local infection ; under the latter 
circumstance they may assume a gangrenous type. The treatment is, 
that for any form of abscess — poultices, preferably in the form of hot 
compresses, early incisions, antiseptic solutions, and tonics. 

LUMBAGO. 

This is a form of myalgia or muscular rheumatism of the muscles 
of the loins and small of the back, and is frequently the result of 
lifting heavy weights, or it results from other strains. In many cases 
acupuncture is very useful, particularly if the trouble is bilateral. 
Sometimes after the employment of this measure the patient can 
straighten the back at once and retain that position. In other in- 
stances antipyrine or acetanilide, in 10 to 20-grain doses of the former 
and 4 to 8-grain doses of the latter, are of service, and iodide of potas- 
sium and salicylic acid are not to be forgotten if the condition of the 
patient does not rapidly improve. Phenacetine and salol are also 
useful combined or alone. A large hot poultice applied to the back is 
often efficacious in obstinate cases. Sometimes a hot foot-bath and a 
Dover's powder on going to bed will produce a cure, and ironing the 
back with an ordinary hot laundry iron at a proper heat, a piece of 
newspaper or cloth being placed over the skin under the iron, is very 
efficient. Counter -irritation in the shape of a blister, a mustard 
plaster or capsicum draft, will often give relief. 

Where these measures fail the reverse treatment may be tried, such 
as an ice-bag placed over the loins, or an ether spray turned on the 
part until the skin is greatly blanched. 

MALARIAL FEVER. 
(See Intermittent and Remittent Fevers.) 

MANIA, ACUTE. 

Space is wanting to consider the thorough and complete treatment 
of mania as it comes to the neurologist. All that can be done here is 



544: DISEASES. 

to denote temporary measures suitable for cases which are brief in 
their course. 

In those cases which occur after confinement and are not supposed 
to be based upon permanent trouble, cimicifuga racemosa is said to be 
very useful in the dose of 20 to 30 drops of the fluid extract three 
times a day, while for the rapid quieting of the patient we may use 
hyoscine hydrobromate in the dose of yjj grain. In other instances, 
if the kidneys and heart are healthy, full doses of chloral may be 
used, and if an active preparation of cannabis indica can be had, at 
least 1 grain of the solid extract, or 1 drachm of the tincture, should 
be employed. Cannabis indica will be found particularly serviceable 
if 60 grains of one of the bromides can be combined with it. 

Where a patient suffering from mania is so violent that nothing 
can be done with him, he should be held, and an emetic dose of y 1 ^- 
grain of apomorphine be given hypodermically, to produce vomiting 
and so relax the muscular system, or he may be tied or anaesthetized 
sufficiently to enable the physician to administer proper remedies. 
Sometimes full doses of morphine are needful, and in others a cold 
douche to the head, while the body is in hot water, is of service. 



MELANCHOLIA. 

This is not the place for a discussion of melancholia of so severe a 
form as to amount to insanity, since the treatment of this latter state 
is very various and largely depends upon the skill of trained physi- 
cians who are alienists. 

There is one form of melancholia, however, which may often be 
rapidly relieved by a simple measure. It is that dependent upon the 
condition of the system in which oxaluria is present. Whenever an 
individual complains of melancholia the urine should be examined, 
and if any oxalate crystals are found, deeply orange-colored, not 
diluted, fresh nitro-muriatic acid should be given in the dose of 5 
drops after each meal in a half-tumblerful or more of water. In 
order to guard against errors in diagnosis it is well to remember that 
pears, tomatoes, and cabbage, all cause oxalates to appear in the urine 
for a short period after their ingestion. 



MENINGITIS, ACUTE. 

Meningitis is to be treated as is any other form of acute inflamma- 
tion occurring in a sthenic or dynamic individual, and particularly 
does its treatment correspond to that of the other inflammations of 
large serous membranes, such as peritonitis or pleurisy. 

In the early stages the patient should receive sufficiently large doses 
of aconite or veratrum viride to strongly impress the circulatory 
system. These drugs have the power of producing such dilatation of 
the blood-paths throughout the body that the congested or inflamed 



ACUTE. 545 

area is relieved of its excess of blood, because the pressure being less 
elsewhere the blood obeys the law that liquids always try to escape 
from pressure, and so leaves the meninges of the brain for the vessels 
of the limbs and trunk. A good-sized blister should always be placed 
at the nape of the neck as a counter-irritant to prevent effusion. 

The proper dose of veratrum viride in the form of the tincture is 
3 drops every hour until the skin becomes moist or nausea is devel- 
oped. 1 The tincture of aconite is also useful in full dose. If great 
arterial excitement is present venesection may be practised (see Bleed- 
ing), but veratrum viride or aconite are better remedies if they are at 
hand. Associated with these two drugs we should employ mercury 
and opium, the first for its antiphlogistic influence, the second for its 
power in allaying irritation. One-fourth grain of powdered opium 
and J grain of calomel may be given every hour until the full effect 
of the opium or mercury is manifested. In some instances the de- 
odorized tincture of opium ( Tinctura opii deodorata) is better than the 
erude drug, in the dose of 2 to 5 drops every one or two hours. 
Sometimes belladonna is of great service, and this is particularly the 
•case where the drugs already named are contra-indicated because of a 
condition of weakness or asthenia. In both conditions ergot is of 
value in allaying the congestion, but its period for exerting a favor- 
able effect is not at the very first part of the attack, but a little later 
when the stage of exudation is at hand. During the first acute stage 
an ice-bag should be applied to the head, both for its local influence 
and antipyretic effect, and leeches may be put at the nape of the neck 
with advantage. As the disease advances and the nervous disorders 
of the affection become marked, nervous sedatives are required to 
allay the twitchings, muscular spasms, or convulsions, and for this 
purpose no drugs are to compared to chloral and the bromides. 

The doses to be used vary with the violence of the symptoms, but 
it may be stated that the chloral should rarely, if ever, be used in 
doses above 10 grains, and the bromides given in the dose of from 
5 to 40 grains. If coma comes on, a large blister should be applied 
to the nape of the neck. 

Quinine has been recommended in meningitis, but it is absolutely 
contra-indicated, as it predisposes to this condition. It may be em- 
ployed only in convalescence and then used most carefully. 

The treatment of the second stage of meningitis must be necessarily 
supportive owiug to the reaction consequent upon great nervous and 
arterial excitement. Under these circumstances the use of opium is 
still indicated, because it allays nervous unrest and supports the 
system, partly by conserving the tissues and partly by inhibiting the 
waste of nervous force apt to occur at this time. Alcohol should be 
given with the food if weakness is present, and a very simple milk 
diet insisted upon. 

1 It is to be remembered that veratrum viride often causes nausea and even vomit- 
ing in susceptible persons, and in consequence it should be carefully given in 
meningitis, lest if vomiting come on the disease be made worse. 

35 



546 DISEASES. 

MIGRAINE. 
(See Neuralgia.) 



MUSO^I VOLITANTES. 

Muscse volitantes is the name applied to the dark specks which 
patients frequently see floating across their fields of vision, especially if 
the eyes are directed toward a bright sky or a white page. Usually 
they indicate no disease of the vitreous humor and the ophthalmoscope 
fails to detect abnormal changes. They are attributed to torpidity of 
the liver by the laity. Muscat volitantes may indicate eye-strain, and 
if the refraction is abnormal this should be corrected ; a mild course 
of alteratives is often a useful adjuvant. 



MYALGIA. 

Soreness of the muscles either on pressure or on movement may be 
dependent upon a number of causes, such as strains, bruises, rheumatic 
taint, or inflammation due to cold. Here, as in many other states, 
the treatment is to be divided into the external and the internal 
methods. Of the internal remedies the best are the salicylates or the 
iodide of potassium, if rheumatism be at the base of the trouble. On 
the other hand, if a bruise or cold be the cause, the chloride of ammo- 
nium will be of service in 10 or 20-grain doses given in a solution 
with extract of liquorice (for prescription see Bronchitis). Other 
remedies which may be tried with a good chance of success are full 
doses of a good fluid extract of cimicifuga (20 drops to 1 drachm) or 
the citrate or acetate of potassium in 20-grain doses. 

The local medications are numerous, but only a few can be consid- 
ered as worthy of routine employment. The chief one is iodine, in 
the form of the pure ointment, or diluted one-half with lard if the 
skin is easily irritated. Another method is to employ a liniment, well 
rubbed in, made up as follows : 

R. — Tr. belladonna? . . . . . . f gj. 

Tr. aconiti . f 3 Ij . 

Tr. opii ....... f^ij. 

Liniment, saponis . . . q. s. ad f^vj. M. 

S. — Poison. To be used externally and only as a liniment. 

Sometimes chloroform liniment is singularly successful, and poul- 
tices applied as hot as can be borne and covered by oil-silk and cotton 
to retain the heat, are often of great value. Massage or good rubbing 
is also a sine qua non for successful treatment in this state. 



NASAL CATARRH, ATROPHIC. 547 

NASAL CATARRH, ATROPHIC. 

(Synonym : Atrophic Rhinitis.) 

The atrophic or last stage of nasal catarrh , commonly known as dry 
catarrh, is a natural sequence of the stage of hypertrophy ; although 
in exceptional instances the atrophic type has appeared at once. In- 
creased vascularity and over-stimulation of the hypertrophic stage lead 
to increased functional activity, and finally to exhaustion and atrophy 
of the tissues involved. 

In atrophic nasal catarrh the nostrils are roomy and the mucous 
membrane red and shiny. The formation of connective tissue has, 
to a great degree, obliterated the delicate serous glands, and the dis- 
charge of mucus, no longer diluted, forms inspissated crusts, which 
adhere to the mucous membrane of the septum and turbinated bones. 

Areas of ulcerated or abraded membrane are disclosed upon removal 
of these adherent crusts. 

The turbinated bones are gradually absorbed and the secreting 
surface thereby much reduced. Sometimes the wasting is so great that 
the posterior wall of the pharynx is clearly visible from the front. The 
inspissated secretion may make a cast of the nostril, and as fresh layers 
form underneath, the oldest part is raised until the whole interior of 
the nostril becomes a mass of decomposition, giving rise to an over- 
powering stench. This form of catarrh causes loss of the sense of 
smell, and the odor is not recognized by the patient himself. Ulcera- 
tion or caries of the bony structure produces an odor even worse than 
the so-called ozwna, The pharynx suffers from the general wasting 
and presents a dry, varnished appearance called pharyngitis sicca, 
which is rather a symptom of nasal atrophy than a separate disease of 
the pharynx. 

The indications are the removal of all accumulations in the nose and 
naso-pharynx and the healing of abraded or ulcerated surfaces. The 
early removal of dead bone is imperative, and what secreting surface 
remains, as far as possible, must be stimulated to compensate, in a 
measure, for the glands that are hopelessly destroyed. In other words, 
our efforts are directed toward producing a compensatory hypertrophy 
of the glandular tissue that remains. Therefore, with the use of anti- 
sepsis we combine alteratives and local stimulation. 

The nose should be thoroughly cleansed with an alkaline wash — 
Dobell's solution — warmed to increase its solvent power. To relieve 
the odor increase the amount of carbolic acid or substitute for it 
eucalyptol and thymol in the wash. Listerine contains both of these 
and may be added to the wash. Its own pungent odor masks some- 
what the offensive odor. Permanganate of potassium may be used in 
weak solutions, but it is painful except when sensation is entirely lost. 
Peroxide of hydrogen is recommended, but the writer has had no ex- 
perience in using it over such an extensive surface. 

The solutions are best applied by means of an atomizer or post- 



548 DISEASES. 

nasal syringe in the hands of the physician, or by snuffing from the 
hand or cup. 

The odor, if due to decomposition, is much decreased as soon as the 
passages are clear. The discharge must never be allowed to re-accu- 
mulate, or much time will be lost. 

Ulcerations require local stimulation by a strong solution of nitrate 
of silver or a superficial application of the flat surface of the galvano- 
cautery heated to a dull redness. Necrosed bone should be removed, 
and it is often found detached in the nostril. 

Local stimulants should be judiciously combined with alteratives. 
Powders of nitrate of silver in starch, varying in strength from 1 to 
10 grains to 2J drachms of the latter, may be blown into the nostrils 
by means of an insufflator. Cover gently the whole surface with a 
thin layer, and use it only of sufficient strength to be slightly felt. 
Nitrate of silver in solution, 1 to 10 grains to 1 fluidounce, gives 
better results at other times when applied to the mucous membrane. 
Avoid over-stimulating and so exhausting the glands which it is 
wished to strengthen. The use of alteratives may alternate with the 
silver salt and iodide of potassium, and this may be done by using 
solutions of iodine and glycerin, as recommended for hypertrophic 
nasal catarrh. Internally, the physician should employ iodide of 
potassium to increase nasal secretion and mucous membrane stimulants 
and tonics. He should also pay attention to the activity of the skin. 



NASAL CATARRH, CHRONIC. 

Chronic nasal catarrh is essentially a disease of civilization, which 
may occur at any period of life, but more commonly develops from 
youth to early adult life. 

Although more prevalent among the upper classes, it is in the 
lower ranks that it most frequently reaches its later stages and its 
worst forms. This does not result from lack of opportunity for treat- 
ment, but from the ignorance or indifference which this class show to 
diseases while there is no suffering and no interference with business. 

Continued exposure to the action of irritants of various characters, 
in the form of dust or particles floating in the air, keeps the mucous 
membranes in a state of constant irritation, A low grade of inflam- 
mation is established, resulting in permanent thickening of the 
mucous membrane, and of the submucous connective tissue, with 
dilatation or actual hypertrophy of the erectile tissue covering the 
turbinated bones. The swollen tissues obstruct the passage of air 
through the nostrils, and mouth-breathing results, with its train of 
symptoms. 

The most common cause of catarrh is found in repeated attacks of 
coryza, each attack increasing the thickening of the mucous mem- 
branes and narrowing the breathing-space. 

Nasal catarrh, in its course, passes through three stages or periods, 



NASAL CATARRH, CHRONIC. 549 

namely, the stage of coryza or acute nasal catarrh, and the chronic 
stages known as hypertrophic and atrophic nasal catarrh. 

Coryza, or cold in the head, is not strictly a stage of nasal catarrh, 
but, as stated elsewhere, is an acute inflammation of the nasal mucous 
membranes, generally running a definite course and terminating in 
recovery in a week or ten days. Its chief clinical importance, how- 
ever, is derived from its tendency, when the vitality is reduced or 
recovery is retarded, to pass into a chronic stage which, to all intents, 
is identical with the hypertrophic stage of nasal catarrh. The line of 
demarcation is not clearly drawn between these two diseases or stages, 
nor can we locate with absolute certainty the point where acute coryza 
becomes hypertrophic nasal catarrh. 

Atrophic nasal catarrh commonly develops from the hypertrophic 
stage, although occasionally the disease takes this form from the begin- 
ning. Its symptoms are essentially different from the other stages, 
being characterized by functional inactivity and derangement in place 
of the over-stimulation of the hypertrophic stage. 

Hypertrophic nasal catarrh commonly has its origin in a neglected 
cold in the head, or in a series of colds occurring in rapid succession, 
keeping the nose in a congested state until the erectile tissue covering 
the turbinated bones loses in a measure its power of contracting, and, 
decreasing the calibre of the nostrils, becomes a source of permanent 
obstruction to breathing. 

As the disease increases there is increased susceptibility to cold. 
Slight exposure produces a stuffy feeling in the nose. The nostrils 
may become completely occluded ; usually, however, only one side 
at a time is obstructed at first — the obstruction showing a tendency 
to change sides. This change is most noticeable in turning in bed, 
the lower side usually stopping, and on changing the position the 
obstruction is reversed, the clearing being accompanied by a crack- 
ling sensation. A slight tickling cough and tendency to clear the^ 
throat in the mornings may result from irritation of the pharynx or 
larynx. 

The nasal obstruction, generally greatest at night, causes restless, 
troubled sleep, while the mouth-breathing leaves the tongue dry and 
coated in the morning. A dull, frontal headache, due to reflex irri- 
tation from intra-nasal pressure, is not uncommon. Unusual irrita- 
bility of the mucous membranes may result in frequent attacks of 
sneezing or in a free watery secretion, which is more active in cold 
weather, appearing as a drop of w T ater, resembling a bead at the end 
of the nostril, which may drip from the nose on leaning forward. 

In patients of a neurotic type, attacks resembling acute coryza occur 
without a moment's warning, and subside as quickly as they come. 
The nose at such times becomes stopped up to an oppressive degree, 
with free secretion, with or without violent sneezing. 

Such attacks are precipitated by exposure to a close or impure 
atmosphere or to dampness, especially at dusk when the dew is falling 
or when the patient is fatigued. The voice becomes husky or altered 



550 DISEASES. 

in character from loss of nasal resonance. Catarrh of the middle ear 
is liable to occur. 

During the early stage of hypertrophic rhinitis, on inspection of the 
anterior nasal passages, all the tissues appear red aud highly vascular. 
Along the surface and margin of the lower, aud perhaps the middle, 
turbinated bones the tissues are swollen and puffy, and in severe cases 
these puffy bags adapt themselves to the shape of the nostril, com- 
pletely closing the passage-way. This does not ofteu completely close 
both sides, except during an acute attack of coryza. One or the other 
side, as a rule, remains open, with a tendency for the obstruction to 
reverse sides. The nervous impression produced by examination may 
cause temporary contraction and clearing of both sides, which, unfor- 
tunately, are soon as bad as ever. 

The swellings, as described elsewhere, consist of cavernous blood- 
vessel tissue, which has the property of filling with blood and erect- 
ing, under stimulus. These swellings on the turbinated bones are 
known as hypertrophies, although at this stage they contain little 
hypertrophied tissue, but are, more strictly, bags of erectile tissue 
which have lost the power of contracting. They readily disappear 
upon pressure by means of a probe, but return at once when the 
pressure is withdrawn. Applications of cocaine (4 per cent, solution) 
produce some contraction, benumbing and blanching the tissues at the 
same time. 

The power cocaine possesses, of contracting hypertrophied tissue, is 
useful for purposes of diagnosis in hypertrophic nasal catarrh. By 
its use we may readily distinguish tumors, or bony or cartilaginous 
growths, from the erectile tissue. 

The long continuation of a low r grade of inflammation favors the 
formation of connective tissue and actual hypertrophy of the turbin- 
ated tissues, which become larger and firmer, and do not completely 
disappear under pressure from a probe. At the same time a progres- 
sive increase in the nasal obstruction is observed. 

A rhinoscopic view posteriorly reveals a similar state of affairs, and 
a hypertrophy developing on the middle or lower turbinated bone — 
rarely on the upper. At this position the hypertrophy appears as a 
round, globular tumor, extending backward toward the vault of the 
pharynx. It is sometimes sessile, but often has a slight constriction 
at its attachment to the turbinated bone. It is occasionally pale and 
covered with mucus — indeed, a collection of mucus may be mistaken 
for a hypertrophy. Cleansing the nose with a solution sprayed by 
means of an atomizer directed through the nose from the front, or by 
a post-nasal syringe from behind, clears the diagnosis. 

At other times a posterior hypertrophy becomes engorged with blood, 
and presents a deep purple color, resembling, in size and shape, a red 
raspberry. 

Enlarged pharyngeal tonsils produce decided obstruction posteriorly, 
and, by the secretion of large quantities of mucus, cause a constant 
feeling of fulness, with a desire to " hawk aud spit." 

An enlarged pharyngeal tonsil is recognized as a soft, spongy mass 



NASAL CATARRH, CHRONIC. 551 

in the vault of the pharynx. Occasionally it hangs down in festoons 
which somewhat resemble stalactites hanging from the roof of a cave. 
Should one of these stalactites become eroded it may cause frequent 
and alarming haemorrhages. 

Hypertrophy of the pharyngeal tonsil is more common in children 
than in adults, and frequently occurs in connection with hypertro- 
phied faucial tonsils or in conjunction with adenitis, or results from 
diphtheria or scarlet fever, or as part of a strumous diathesis. 

Hypertrophied tonsil is a fruitful source of deafuess in children, 
as it may become large enough to interfere with the passage of air 
through the Eustachian tube, or cause extension of catarrh to the 
middle ear. 

When a child is too small to permit a rhinoscopic examination, the 
presence of an enlarged pharyngeal tonsil may be felt by introducing 
the index-finger through the mouth up behind the soft palate, taking 
care that the finger is protected from the child's sharp teeth. 

It is well to educate the finger to recognize the size and shape of 
the naso-pharynx, although its introduction is a disagreeable perform- 
ance, for it may aid materially in outlining the structure, consistency, 
or point of attachment of tumors projecting from the nose into this 
space, or even assist in engaging a large growth in the loop of wire 
from a snare introduced through the nose. The ear should be educated 
to recognize the different effects produced on the voice by obstructions 
in the front or back of the nose and so assist the eye in diagnosis. 

Occlusion of the nostrils, if well in front, gives a nasal sound to 
the voice from the peut-up vibrations in the nose and naso-pharynx. 
An obstruction at the back of the nose deadens the voice, interferes 
with its carrying power, and prevents the voice being heard at any 
distance from the speaker. The voice, to use a technical term, loses 
its timbre, and should it be used to any extent chronic laryngitis 
results. The extra pressure injures the larynx, and tires the throat, 
without increasing the carrying power. 

The pathological changes occurring in hypertrophic nasal catarrh 
do not differ materially from similar changes occurring in catarrhal 
inflammations elsewhere. In treating catarrh, find the cause, and, if 
possible, remove it. Great assistance in this direction may follow 
careful inquiry into the occupation and environment of the patient. 

The difference between nasal catarrh and simple catarrh occurring 
in other places is chiefly the result of location. The nasal mucous 
membranes are surrounded by bony w T alls which limit the power of 
swelling to one direction, namely, toward the centre. This affects the 
main function of the nose, that of respiration, and obstructed respira- 
tion leads at once to a train of symptoms, not of catarrh, but of the 
results of catarrh. 

Swelling of the turbinated tissue and nasal obstruction are early 
symptoms of hypertrophic nasal catarrh. The change in functional 
activity which is caused by obstruction to respiration, and the nervous 
irritation resulting from pressure, sooner or later produce permanent 
injury, either local or reflex. 



552 DISEASES. 

The first indications for treatment are the reduction of inflammation 
and restoration of the breathing space. 

As the chief function of the nose is respiratory, the reestablishment 
of free nasal respiration, combined with the liberal use of autiseptic 
washes, will lessen the inflammation and irritation and produce a 
healthier state of the secretions. 

The writer places cleanliness at the head of the list of remedial 
measures. The alkaline wash recommended on page 547, sprayed 
into the nose by a hand atomizer, or gently snuffed from the palm of 
the hand or from, a small cup, gives good results. The hand warms 
the solution slightly, but when snuffed from a cup the solution should 
be artificially warmed. This wash may be used two or more times a 
day. 

The nasal douche should never be used where there is nasal obstruc- 
tion, on account of the risk of forcing the solution into the Eustachian 
tube and causing catarrh of the middle ear. 

In addition to the antiseptic wash, where the mucous membrane is 
congested and irritable, the treatment recommended for coryza may 
be instituted for a few days with good results. A solution composed 
of equal parts of distilled extract of hamamelisand water, or a dilute 
solution of hydrastis, may be sprayed into the nose during the acute 
stage. 

A little later a spray of ferric alum, 5 grains to the ounce, may be 
applied carefully, in an atomizer, iby the physician. 

It is not advisable to use alum in any considerable strength in the 
nose, as its continued use is liable to impair the sense of smell. 

The alterative and absorbent action of iodine makes it a valuable 
remedy for local application in chronic nasal catarrh. Combine it 
with glycerin in the strength of 6 or 8 grains to the ounce, with 
enough potassium iodide to make a solution. Apply this by means 
of a piece of absorbent cotton on the end of an applicator, along the 
floor of the nose, until it reaches the pharynx. It is needless to say 
that such an application as this should be made with the utmost 
gentleness. The cotton should project beyond the probe, and care 
should be taken to avoid bruising the tissues. 

After the acute stage has subsided, as shown by the disappearance 
of the livid color and lessened sensibility, any remaining hypertro- 
phied tissue should be removed by a snare or the galvano-cautery. 



NEURALGIA. 

Like headache, neuralgia gives rise to most of the suffering experi- 
enced by active persons who are not sick enough for bed and to those 
who are confined to bed by other diseases. It affects members of every 
walk of life, aud may be so severe as entirely to incapacitate the most 
powerful of men. 

The causes of neuralgia are very various, but they may be 
briefly stated to depend chiefly upon malnutrition, over-work, 



NEURALGIA. 553 

nervous excitement, with consequent reaction, and to reflex irritation 
from diseased organs, as in the case of supra-orbital neuralgia from 
eye-strain, or ovarian irritation from uterine inflammation. Nerves 
functionally diseased are always more or less active than normal ; that 
is, 7i?/per-excited or hypo- excited, above or below par. In both cases 
they must be brought back to their normal tone by appropriate 
remedies, and these consist in nervous excitants and nervous seda- 
tives. To give a nerve already depressed the additional depression 
of a bromide, or a nerve excited the additional excitement of strych- 
nine is absurd. 

From what has just been said it becomes evident that the physician 
must always determine the condition of the system of his patient, 
and the causes of that condition, before administering remedies. 

The treatment of this disease, from its curative standpoint may be 
divided into the use of tonics, nutritives, and palliatives. 

Where neuralgia is associated with anaemia no hope of permanent 
relief can be looked for, unless iron and arsenic are used until the 
ansemia is cured, and it is often necessary to combine with these 
drugs the use of cod-liver oil and bitter tonics. These are the cases, 
too, in which mix vomica or strychnine raises the depressed nerves to 
increased activity and so bring relief. How they do this is not known, 
but we know enough to recognize one or two important facts. Strych- 
nine is certainly a nervous stimulant, and is also a stimulant to the 
anterior columns of the spinal cord. It probably also acts upon the 
trophic centres in the anterior cornua of the spinal cord, and by 
stimulating these centres increases the nutrition of the tributary nerve 
fibres. 

It is needless to state that the neuralgias of syphilis and scrofulosis 
are to be treated by the specific remedies directed to the cure of these 
affections, while at the same time the various symptoms are carefully 
controlled by appropriate palliatives. 

When nervous exhaustion causes neuralgia phosphorus is a useful 
remedy, particularly in those cases which are convalescing from acute 
fevers. 

Sometimes malarial poisoning produces a violent form of supra- 
orbital pain known as " brow ague," which is to be relieved, not by 
ordinary remedies, but by large doses of quinine. 

The relief of the states producing neuralgia having been spoken 
of, it yet remains for us to consider the measures to be adopted for 
the cure of an attack. Fortunately, the recent advances of thera- 
peutic study have placed in our hands a large list of drugs not apt to 
produce a habit after prolonged use, comparatively safe though active, 
and not of disagreeable taste or general effect. By these terms the 
writer refers to antipyrine, acetanilide, and phenacetine, all of which 
possess wonderful power in the alleviation of pain dependent upon 
true nervous involvement. In order to avoid failure in the use of 
these drugs in the relief of headache we must always remember that 
their field of service is that of neuralgic pain, not other pains. Anti- 
pyrine is to be used in the dose of 5 to 20 grains for ordinary neuralgia, 



554 DISEASES. 

or the pain arising from the crisis of locomotor ataxia, acetanilide in 
the dose of 3 to 8 grains for the same purposes, and phenacetine in 
the same amount as acetanilide. 

Upon these remedies combined with caffeine and the bromides, 
according to circumstances, we now depend ; and the following pre- 
scriptions will be found of service : 

R — Antipyrini ^j vel ^ij 

Caffeinse citratis gr. xx. M- 

Ft. in chart no. x. S. — One every thirty minutes till relieved. 

The following may be of use also : 

R ■ — Antipyrini gj. vel gij. 

Potassii bromidi . . . . . . giij. M. 

Ft in chart no. x. S. — One every thirty minutes till relieved. 

Or, when the caffeine in the first prescription causes nervousness : 

R .—Antipyrini ^j. vel ^ij. 

Caffeinse citratis gr. x. 

Potassii bromidi ^iij. M. 

Ft. in chart no. x. S. — One as above 

In any one of these prescriptions acetanilide or phenacetine may be 
substituted for the autipyrine. 

A very effective remedy in some cases of neuralgia of the fifth nerve 
is croton chloral in from 5 to 20-grain doses in pills of 5 grains each. 

In some cases of anaemic neuralgia of the head nitrite of amyl inha- 
lations have proved useful, by reason of the cephalic flushing produced 
by this drug. 

A very large number of local applications have been used with 
success in obstinate neuralgias and other cases not so difficult of cure. 
Cocaine cannot be applied, as it does not penetrate the skin, but relief 
can sometimes be obtained by the local use of the oleate of aconitine 
painted over the spot if it be limited in area. Much of this alkaloid 
cannot be applied, lest poisoning by absorption occur. 

Where the nerve is very superficial it can often be treated by cold 
with great success. This is accomplished by freezing the parts with 
an ether or rhigolene spray, or by the application of a small package 
of finely chopped ice and salt. Within the last few years the treat- 
ment of neuralgia by kataphoresis (see p. 365) has come into promi- 
nence, and consists in the use of some local anaesthetic, such as chloro- 
form, which is applied over the part on a small piece of lint, and a 
rapidly interrupted current used through the pledget. Under these 
circumstances the anaesthetic passes through the skin and affects the 
nerve. 

A very useful local injection in localized neuralgia is J- to J of a 
grain of morphiue, but the danger of beginning the morphine habit 
is to be remembered when treating chronic cases. Sometimes acu- 
puncture (see p. 337) is of service, and the surgeon may be called 
upon to stretch the nerve or to do a neurectomy. 

There still remains to be considered a form of neuralgia generally 



OBESITY. 555 

known as migraine. This affection is very severe in its manifestations, 
and is often most obstinate in yielding to treatment. Commonly it is 
associated with eye-strain or cerebral disease or other similar causes, 
and these must be removed before a cure is entirely effected. The 
best treatment of most of these attacks is the use of 20 drops of the 
tincture of cannabis indica every hour, if a good preparation can be 
had, or by the use of J to J a grain of the solid extract every two 
hours accompanied by 10 to 20 drops of tincture of gelsemium. 



NIPPLES, SORE. 

Whenever the nipples become sore, so that it is impossible for the 
mother to allow the child to nurse, a solution of cocaine of the 
strength of four grains to the ounce should be applied to the part, 
and washed off carefully just before the child sucks. Following the 
nursing a solution of boric acid, of the strength of 20 grains to the 
ounce of water or mucilage of acacia, may be used over the part, the 
nipple being thoroughly dried beforehand. Where the fissures are 
deep and slow to heal, the tip of a stick of silver nitrate may be 
applied to them with advantage. Some practitioners employ tincture 
of benzoin over the inflamed part, and glycerite of tannin is often of 
value. Cleanliness, dryness, and care of the breast previous to par- 
turition do much toward preventing the condition. 

Sometimes it is necessary to use a breast-pump or nipple-shield 
before a cure can be effected. 



OBESITY. 

Whenever an excess of fat accumulates in the body as part of its 
substance, various discomforts, both mental and physical, arise, and, 
in addition, the normal functions of all the parts are so disturbed or 
interfered with that the continuance of health is often impossible. 
In many cases the deposition of fat about the heart or between its 
fibres results in serious symptoms ; and breathlessness on exertion is 
produced by the obstruction which is offered to the free movements 
of the diaphragm by masses of omental fat, aided by the fact that 
the great weight and bulk of the body require severe muscular 
effort. It is worthy of note, also, that a layer of fat over the body 
increases the vascular surface very greatly, and in consequence gives 
the heart the labor of supplying a larger number of bloodvessels. 

The causes of obesity are numerous. In many families there is an 
inherited tendency, while in others only certain individuals are affected. 
These persons are fat because their systems naturally tend to the 
deposit of obese materials in the same way that the members of one 
family have large bones while another has small bones. The etiology 
of obesity, outside of the causes just named, are very numerous, but 
the chief one is over-indulgence in food. 



556 DISEASES. 

Just at this point it is not out of place to state exactly what over- 
indulgence in food means. Every individual is a law unto him- 
self in regard to the amount of food which is consumed and ingested. 
One often sees large, powerful, wiry men, who eat little, sit beside 
others, not so powerful or large, who eat excessively and who appar- 
ently do not suffer from indigestion in consequence. Neither of these 
two groups become excessively fat, because one represents a grate 
which burns its fuel so that there is no waste, while the other resem- 
bles a grate in which there is always a residue of unburnt coal, which 
is cast out with the ashes as effete matter. As different engines of the 
same build burn varying amounts of coal, so do different men assimi- 
late different amounts of food. No stated amount of food can be set 
down as a man's daily portion, until his case is carefully studied, but 
it is important to remember that the quantity of food is generally in 
direct ratio to the severity of the toil, and that a man who loafs about 
a club, or " takes life easy," often eats more than a day-laborer, of 
far richer foods too, and wonders why he gets stout. In nearly every 
case of obesity not dependent upon gross disorder of the trophic 
nerves, over-indulgence in food is the cause. To some this may seem 
absurd, and the patient will say that he eats just enough to keep him 
from feeling empty between meals, but this does not alter the case in 
the least. The proper amount of food for a man is not what his 
appetite or gastric viscus calls for, but what his system needs. To this 
further reference will be made when considering the diet for obesity, 
found below. 

The very presence of fat aids in the deposition of it, for, by acting 

as a non-conducting pad all over the body, it prevents the dissipation 

of heat, and so decreases the combustion of those substances which, 

when not used for the manufacture of heat, are deposited as fat. 

Again, we nearly always find that obese persons take alcohol with 

their food, thereby increasing the fat in their bodies ; for, finding that 

thev cannot digest all the substances which greediness makes them 

. ... 

swallow, they take alcohol to stimulate their digestive apparatus to 

increased efforts and assimilation. Further than this, alcohol adds 
force to the body, and preserves the tissues by substituting the oxi- 
dizing processes. 

We find, therefore, that three great causes are active in producing 
corpulence in many cases, namely, heredity, over-indulgence in food, 
aud lack of exercise, which is one of the means by which over-indul- 
gence is produced — i. e., less exercise, less food needed, but often more 
eaten. 

The treatment of corpulence rests solely upon the conditions named. 
In all instances the diet is the important point for the bestowal of 
care. Reference has already been made to the fact that the needs of 
the system are the criterion by which we judge the amount of food 
necessary to each case, not the sensations in the stomach. The use of 
coca by the natives of South America enables them to withstand 
hunger and deprivation, not because it gives tissue to the body, but 
because it paralyzes the sensory nerves in the stomach, aud relieves 



OBESITY. 557 

the sensation of hollowness or weakness which we are accustomed to 
overcome in this country, in the absence of food, by tightening our 
belts. Everyone who has undergone severe mental or physical labor 
and missed a regular meal, will remember that about the usual hour 
for the meal his sensation of emptiness may amount to nausea and 
distress, but the hour once passed he feels as strong as before until 
by prolonged toil he so exhausts his powers that the system forces 
him to eat, not so much from hunger as from exhaustion. To under- 
stand this clearly, we must recollect that the system keeps its shares 
of force in the same way as a careful speculator keeps his shares of 
stock, namely, one part in active use for speculation, the other half 
for reserve in case of need. In health the stomach begins to " feel 
hungry " as soon as the speculative shares of force are nearly used, 
in order to cause the ingestion of more food and to preserve the 
" sinking fund " intact. It becomes evident, therefore, that the mere 
presence of hunger is purely a symptom, not an indication of the 
absolute necessity of food, for, if it were, the consumptive would 
be notorious for his appetite, instead of being noteworthy for his 
anorexia. 

The food of the patient suffering from obesity is to be cut down 
gradually, and the character of it arranged so that, though its bulk 
be great, its nutritive properties are small. Beef and other meats are 
concentrated foods containing much nourishment in a small space, 
while lettuce, spinach, cabbage, and nearly all vegetables, except roots 
or tubers, contain a large amount of fibre useless to the body. By 
the use of a carefully arranged vegetable diet in obesity, we cut down 
the actual amount of food absorbed, and, by its bulk, keep the stomach 
so busy at sifting the. nutritious from the non-nutritious materials 
that hunger is not felt, because another meal-time is reached almost 
before the food of the first is assimilated. We find, therefore, that 
the diet for the reduction of corpulence should consist chiefly of bulky 
vegetables, but not too exclusively of any one article or set of articles. 
Heretofore it has been thought that proteids (meats, eggs, etc.) should 
be used to take the place of all hydrocarbons or carbohydrates (fats, 
starches, and sugars), but this is not physiologically correct, as both 
forms of food are always needed for health, and it has been found 
that proteids may be converted into fats in the body. 

The following bill of fare will be found of service in the treatment 
of obesity : 

Breakfast : One or two cups of coffee or tea, without milk or sugar, 
but sweetened with a fraction of a grain of saccharin. Three ounces of 
toasted or ordinary white bread or six ounces of bran bread. Enough 
butter may be used to make the bread palatable, not more than one 
ounce. Sliced raw tomatoes with vinegar, or cooked tomatoes with- 
out any sugar or fats. This diet may be varied by the use of salt or 
fresh fish either at breakfast or at dinner. 

!N"oon meal (dinner) : One soup-plate of bouillon, consomme^ St. 
Julien, or other thin soup, or Liebig's or Johnston's beef essence, fol- 
lowed by one piece of the white meat of any form of bird or fowl. 



558 DISEASES. 

Sometimes a small piece, the size of one's hand, of rare beef or mut- 
ton, but no fat, may be allowed, and this should be accompanied by 
string-beans, celery, stewed or raw ; spinach, kale, cabbage, beans, 
asparagus, leeks, and young onions. Following this, lettuce with 
vinegar and a little olive oil (to make a French dressing), a cup of 
black coffee or one of tea, and a little acid fruit, such as some sour 
grapes, tamarinds, and sour oranges, or lemons, may be taken, and 
followed by a cigar or cigarette. 

Supper should consist of one or two soft-boiled eggs, which may 
also be poached, but not fried, a few ounces of bran bread, some salad 
and fruit, and perhaps a glass or two of light, dry (not sweet) wine, 
if the patient is accustomed to its use. 

Before going to bed, to avoid discomfort from a sensation of hunger 
during the night, the patient may take a meal of ponada or soak 
Graham or bran crackers or biscuits in water and flavor the mass 
with salt and pepper. 

The reduction of diet is generally best accomplished slowly, and 
should be accompanied by measures devoted to the utilization of the 
fat present for the support of the body. Thus the patient should not 
be too heavily clad, either day or night, should resort to exercise, 
daily becoming more severe, and should drink freely of water, pro- 
vided that sweating is established sufficiently freely to prevent the 
accumulation of the liquid in the vessels and tissues. 

Very often a cold bath will, by its dissipation of heat, cause destruc- 
tion of fat, which will be burnt up in the body in the manufacture of 
heat units to maintain the temperature, aud if the patient is not too 
anaemic and stands this exposure to cold well, the bath should be re- 
peated each day or a Turkish bath used instead. 

The bowels should be kept active by laxative fruits or purges, but 
if liquids taken in drink are not eliminated rapidly, saline purges are 
useful, since, if the bloodvessels are engorged, the circulation in the 
capillaries is slow r and a deposit of fat is apt to result. 

Where proper exercise is impossible, the rest cure, with massage, 
electricity, passive exertion, and an absolute skimmed-milk diet, may 
be resorted to, particularly in those persons known as " fat aneemics," 
who have not enough red corpuscles in their blood to carry sufficient 
oxygen to the tissues to complete oxidation. 



PERICARDITIS. 

Inflammation of the pericardial sac is a frequent occurrence, and 
requires prompt treatment. If the case be sthenic, aud is seen early, 
five to ten leeches should be placed over the praecordium, and at the 
same time sufficiently large doses of veratrum viride resorted to, to 
depress the circulation, and by the dilatation of the bloodvessels else- 
where to draw off the blood from the inflamed area. To prevent the 
outpouring of a plastic exudate capable of undergoing organization 



PERITONITIS, ACUTE. 559 

and forming adhesions, calomel should be given in J-grain doses every 
hour, combined with enough opium to prevent purgation. 

Where the case passes from the acute stage of inflammation to that 
in which effusion takes place, the treatment changes at once, and be- 
comes supportive if the system show 7 s signs of failure. The friction- 
sounds of the first stage are now lost, and the heart-sounds may be 
feeble or muffled in tone by reason of the effusion present. Digitalis, 
alcohol, or caffeine may be used if the heart shows signs of failure, but 
when digitalis is used its influence should be carefully watched — since 
the employment of this drug produces a very full diastole or dilata- 
tion of the ventricles, and these are already cramped for space in which 
to dilate, by reason of the exudate which has entered the pericardial 
sac. If the effusion is sufficient to endanger life it should be tapped 
aud aspirated away very gradually. In other instances, if the patient 
is stroug, it is only necessary to administer hydragogue purges, such 
as jalap — 20 grains of the compound jalap powder, or elaterium ^ 
grain, or a saline purgative in concentrated form, before breakfast. 
Often a blister over the prseeordium is of service. 



PERITONITIS, ACUTE. 

An inflammation of the peritoneum, as with any serous membrane,, 
maybe either sthenic and fibrinous or asthenic and serous. The same 
rules hold, therefore, in this case as in all forms of inflammation, 
namely, that circulatory depressauts are only to be used in the first 
type, and followed, if needed, by stimulants; whereas, in the asthenic 
class, the use of stimulants is called for at once and depressants are 
contra-indicated. For many years the profession have recognized 
opium and belladonna — particularly the former — as the most uni- 
versally applicable remedies and best curative drugs for cases of 
peritoneal inflammation, and while a new method of treatment in this 
disease has arisen, it has only proved itself of value in a limited 
number of cases. 

Remembering constantly that peritonitis is an inflammation, the 
course of treatment to be pursued by the physician is by no means 
complicated. While the use of veratrum viride may be resorted to, 
w 7 hen the patient is strong and the pulse hard and tense, aconite may, 
perhaps, in such cases be better, for the double reason that vomiting 
is apt to occur of itself and may be induced by the veratrum viride, 
while aconite decidedly prevents any such tendencies. This is impor- 
tant in view of the fact that vomiting is always to be avoided, lest 
the retching increase the peritoneal inflammation. If vomiting is 
present, this and the pain should be controlled by the use of large 
doses of opium and belladonna — say J grain of the extract of each 
to an adult, and these should* be accompanied by the application of 
leeches to the abdominal wall in large numbers — from 10 to 30. If 
these cannot be had, a mustard plaster may be used. If the vomiting 
is too severe to permit of the administration of drugs by the mouth, 



560 DISEASES. 

they must be given by the rectum in J pint of starch- water, laudanum 
and the tincture of belladonna being employed in the proportion of 
1 drachm each. 

Opium can always be taken in full dose by those suffering severe 
pain, and it seems to be particularly well borne in peritonitis. The 
use of this drug in peritonitis, as with all other drugs in medicine, is 
not governed by the amount in grains which has been used, but by 
the effects which it produces. There seems, too, to be some evidence 
that belladonna can be taken in full amounts without disagreeable 
results ; and the same rule applies with equal effect to belladonna, it 
being given for the influence exerted and not according to the number 
of grains used. Both of these drugs, unlike depressants and stimu- 
lants, may be used in all forms of peritonitis and in all stages, if called 
for, but the leeches and counter-irritation are limited in their use to 
the early periods of the attack. 

The use of calomel in peritonitis is highly praised by some and 
condemned by others, largely because its proper sphere is not recog- 
nized. Mercury does good only in the severe acute forms of peri- 
tonitis which arise from traumatism or other cause, and is to be used 
for the liquefaction or changing of a fibrinous exudate into a serous 
exudate incapable of undergoing organization. If, on the other hand, 
the peritonitis be tubercular, or occurs in the course of some exhaust- 
ing disease which has largely sapped the patient's strength, the use of 
mercury is exceedingly harmful and tends to increase the danger of a 
fatal result. 

The remaining directions which the physician should give are: abso- 
lute rest, which is nearly always adhered to voluntarily by the patient 
owing to the pain, and the use of small quantities of predigested — 
that is, paucreatized — milk administered every few hours or every 
hour in small quantities. 

Often in peritonitis the inflammation extends to the bowels, and 
paralysis of their muscular fibres occurs. As a result of this, obsti- 
nate constipation ensues which is not to be overcome by purges, 
which if mild will not act and if severe are dangerous, but by the 
use of belladonna and opium already spoken of. The rationale of 
this treatment is not far to seek in the light of our present physi- 
ological knowledge. Belladonna acts as an antispasmodic upon all 
unstriped muscular fibre, and in the large doses which should be given 
in peritonitis depresses the peripheral ends of the splanchnic or in- 
hibitory intestinal nerves. In this way the muscular fibres which 
are in spasm become relaxed so that peristaltic waves may freely move. 
The value of the opium, also, is apparent; for it allays irritation and 
prevents the reflex muscular spasm dependent upon the pain and 
inflammation. Obstinate constipation after the ingestion of irritant 
foods, such as putrid meat, will often be relieved by opium and 
belladonna as effectively as if the patierit was purged by an ordinary 
purgative. 

Very frequently in acute peritonitis tympanites becomes not only 
a very painful, but even a dangerous symptom, the distention of the 



ACUTE. 561 

belly beiDg very great. This may be much relieved by the employ- 
ment of turpentine stupes (see Turpentine), and in some cases by the 
rectal injection of milk of asafoetida, or better still, turpentine J to 1 
drachm, milk of asafoetida 3 ounces, and warm watei, 4 ounces. 

Not content with having made a vast stride forward during the 
past few years, abdominal surgery brings with it not only new 
methods of treating diseases in this region by the knife, but also 
has given us a method of curing peritonitis by the use of saline 
purgatives which is certainly of the greatest value in those sudden 
inflammatory conditions which occasionally spring into life after 
operations upon the abdominal area. It will be remembered that 
abdominal surgeons have been the chief advocates of this treatment for 
several years, and that the wonderful results which they have obtained, 
the reputation of the reporters, and the complete reversal of all our 
ideas concerning the treatment of the disease, have called forth not 
only an enormous number of trials of the method in this country, but 
have also brought forth two opposing factions in the profession. The 
first of these is chiefly composed of surgeons, the second of persons 
who in a long experience have reached good results by older methods, 
and who are generally physicians. The first class dogmatically assert 
that the physician should turn over every case of peritonitis to the 
surgeon to be opened, searched, and purged ; the second class do not 
deny that saline purgatives do good in the hands of the surgeon, but 
are more conservative in their opinions concerning the general meas- 
ures to be employed in all cases of peritonitis. 

Again, it would seem impossible at the present time to assert that 
peritonitis may be either idiopathic or traumatic without bringing 
upon one's head a storm of criticism ; for on the one side we have a 
number of physicians who believe that peritonitis may arise without 
any direct exciting cause, and on the other hand an equally large 
body of observers who assert that it is essentially a secondary in- 
flammation brought on by direct contiguity with an already inflamed 
tissue, or else that the inflammation is set up by the escape of foreign 
bodies into the peritoneal cavity, or by pathological changes occur- 
ring in organs normally situated in these regions, as for example, 
fibroid enlargements of the uterus with impaction in the pelvis, or 
pyosalpinx. 

As it is absolutely impossible for either side at present to prove that 
their opponents are wrong, and as both sides are not to be doubted in 
the integrity of their observations, the unbiased judge can but come 
to the conclusion that, as yet, we have a right to believe that idio- 
pathic peritonitis may exist. 

If those observers are correct who believe that no peritonitis arises 
save as the result of some one of these conditions, then the attempt, on 
the part of the physician to treat such a case is criminal negligence, 
and, as such, cannot be too severely condemned ; but too many cases 
of peritonitis are to-day walking examples of the value of the use of 
opium to permit of anyone asserting that this treatment is useless, or 

36 



562 DISEASES. 

that the knife of the surgeon is to be used in every case : yet some of 
the more radical members of the profession would have us believe 
that the abdomen should be opened solely for the purpose of making 
a diagnosis, and that this having been done and no intestinal compli- 
cations found, salines should be given. 

Whether the inflammation be idiopathic or not has little to do, 
however, with the methods which we are to resort to in the medical 
treatment of this condition. It cannot be gainsaid that the results 
obtained by surgeons in the use of saline purgatives have been start- 
lingly brilliant ; neither can anyone deny that their methods may 
sometimes be employed in medicine as well as in surgery ; but there 
are several points to be recalled by both parties which we think so 
seriously modify the views of each as, after all, to unite them in a 
bond of unanimity. No one denies that the surgeon does rightly 
when he uses salines to prevent peritonitis after an operation ; but 
the knowledge of the condition of the patient after he has been oper- 
ated upon by the surgeon, and that possessed by the physician when 
called to see a case of peritonitis, are radically different : for the sur- 
geon has a right to believe that the intestinal canal is patulous and 
devoid of impactions and intussusceptions, while the latter knows 
not whether he has before him an inflammation of the peritoneum 
without intestinal involvement or inflammation dependent upon some 
abnormality in the prima via. As a consequence it is perfectly 
proper for surgeons to administer salines which, to use their own 
words, not only deplete the abdominal bloodvessels, but also by the 
increased peristaltic movements produced, prevent adhesions ; while 
the physician in the case of peritonitis from perforation, impaction, 
or intussusception may do the patient an immense amount of harm 
by such a procedure long before it is possible to decide what the cause 
of the trouble may be. It is evident, therefore, that the opium 
treatment must be adhered to, at least until the diagnosis is formed, 
unless at the very first sign of pain an exploratory incision is made 
instead of using those remedies generally employed in ordinary attacks 
of abdominal discomfort; and it should not be forgotten that pain 
and tenderness with inflammation are the symptoms of peritonitis, not 
only after section, but also of many other states in the ordinary indi- 
vidual. 

It is also evident that other conditions may exist which render the 
administration of purges unjustifiable, and iu which the use of the 
knife by the surgeon is not to be thought of. It is undeniable that 
the surgeon should be summoned the moment a suspicion of perfora- 
tion arises, but in the case of a person in whom an enteritis has arisen 
locally by an old adhesion, increased peristaltic movement is equivalent 
to strapping the normal side of the chest in pleurisy with the object of 
giving the diseased side more exercise. 

Again, it is of the gravest importance that both the physician and 
surgeon should distinguish very clearly between an inflammation of 
the peritoneum in a strong, healthy person, and in one who is in a 



PERNICIOUS MALARIAL FEVER. 563 

condition of vital depression, or exhaustion from prolonged disease 
elsewhere. Depletion by means of purges is, of course, in the first 
class, as much indicated as the application of leeches or bleeding, but 
in the second class, quite as strongly contra-indicated. In the dyna- 
mic form of inflammation there is danger of adhesions being formed 
by reason of the fibrinous exudate thrown out ; in the adynamic con- 
dition of inflammation there is already an enormous exudation of serum 
into the abdominal cavity which purges cannot remove until they have 
drained off a large amount of liquid from the blood. 

Again, there are some cases of peritonitis which are ushered in by 
an acute paroxysm of pain, but which do not continue during their 
whole course as dynamic cases, and in which depletion at first results 
in exhaustion later on. 

Until the profession have employed these two methods side by side, 
with an absolutely unbiased opinion, for a long period of time, the 
only proper conclusion to be reached seems to the writer to be this, 
namely, that in acute peritonitis, suddenly lighted up in a surgical 
case, and which is recognized almost at the moment of its birth by the 
ever-watchful surgeon, who is on the lookout for it, salines may be 
given ; whereas, in the case which the physician rarely sees till hours 
have elapsed, and in which grave doubt exists as to the cause of the 
trouble, opium and external methods of depletion must be resorted to. 



PERNICIOUS MALARIAL FEVER. 

This is one of the most acutely dangerous diseases known to man, 
if it be fully developed, and requires the greatest activity and skill 
on the part of the physician, who may be called upon to treat a large 
number of widely varying symptoms, all of a pressing nature, at one 
and the same time. The chief indication is for the use of quinine, in 
its most soluble forms, in solution and in large doses, which may 
amount to 60 or 100 grains, by the mouth, by the bowel, and hypo- 
dermically. 

The manner in which quinine acts in malarial poisoning is now 
generally conceded to depend upon its influence over the malarial 
germ of Laveran, which has been so well studied in America by 
Osier and Councilman. All the students of the subject have found 
that at least some of these bodies are made inactive and disappear 
under the iufluence of the drug, and we have at last obtained a 
knowledge as to the manner in which quinine does good, which in its 
absence was a constant opprobrium to scientific medicine. The 
saying that "As soon as the physiologist and pathologist tells the 
therapeutist what disease is, the latter will tell how his remedies do 
good," is very well exemplified by the use of quinine in malaria and 
the present, well-founded scientific reasons for its employment. (See 
Intermittent and Remittent Fevers.) 



564 DISEASES. 



PLEURITIS, or PLEURISY. 

Under the consideration of Peritonitis, the writer has already 
given so full an account of the treatment of acute inflammations 
affecting serous membranes or surfaces capable of throwing out a 
croupous or fibrinous exudate, that it seems scarcely necessary to 
repeat the directions here. It is to be remembered that an inflamma- 
tion of the pleura is identical with an inflammation anywhere. The 
treatment of this disease in its early stages is therefore identical with 
other inflammatory diseases, or, in other words, the use of venesection, 
or, better still, of tincture of veratrum viride or aconite to bleed the 
man into his own bloodvessels, is to be resorted to. Along with these 
measures, counter-irritation in the way of blisters, or depletion by wet 
cups is in order ; but dry cups are never to be used in pleurisy over the 
diseased area, since they may produce ecchymosis of the pleura by their 
suction exercised through the intercostal spaces. Where dry cups are 
used they should be employed at some distant spot, as over the skin of 
the back, where the tissues are too dense to permit of pleural involve- 
ment by cupping. In cases which are very sthenic it is best to give 
calomel for its aplastic effect, in order to prevent a fibrinous exudate. 
By this treatment nearly every case of pleuritis, if seen early enough, 
can be aborted. 

When the pain from the pleurisy is excessive and the movements 
of respiration greatly increase the discomfort, strapping the chest-wall 
may be resorted to. This is done for the purpose of immobilizing the 
chest. The straps should consist of adhesive plaster, two and a half 
inches wide and long enough to follow the line of the ribs from the 
vertebras to the sternum. They should be applied tightly during 
expiration, slightly overlapping one another. 

Both in pneumonia and pleurisy a poultice is often useful when 
applied to the chest, but, while this is efficient, it generally soils the 
clothes and slips down to the waist. A cotton jacket is much better. It 
consists of one or two thicknesses of carded cotton basted inside a thin 
undershirt, like a fur-lined coat. On the outside of the shirt oil-silk 
should be basted. By doing this we envelope the chest in a warm 
poultice, because the heat of the body keeps the cotton at the proper 
temperature, while the oil-silk, by preventing evaporation of the 
moisture exhaled from the skin, soon causes the cotton to be moist as 
well as warm. Poultices are forever getting cold and boggy, and if 
not changed make the patient worse. If they are changed, there is 
danger of the patient taking cold ; to avoid such an accident a 
fresh and hot poultice should always be ready by the side of the nurse 
before the old one is taken off, so that as little exposure is suffered as 
possible. 

When the second stage of pleurisy, or the stage of effusion, is 
reached, other lines of treatment are needed. The cardiac sedatives 
have been stopped as soon as the quieting of the circulation, the lessen- 
ing of pain, and the absence of a friction-sound denote the passage of 



PNEUMONIA. 565 

the case from the first stage to the second. If the pulse becomes weak 
and the system is depressed, stimulants in the form of alcohol or digi- 
talis are needed, and special care must be devoted to the condition of 
the exudation in the pleural space. If the effusion is sufficiently large 
to cause dyspnoea on exertion, and is not readily removed by the ad- 
ministration of saline purges at the proper time in concentrated form, or 
if it is not taken up by the vessels after jalap or elaterium is used, then 
resort must be had to aspiration of the liquid by the proper apparatus. 
The physical signs at this time, it will be remembered, consist in flat- 
ness on percussion over the lower portions of the chest, which area of 
flatness generally varies with the change in the position of the patient 
from the erect to the recumbent position, unless the effusion is saccu- 
lated. Blowing or bronchial breathing at the apex of the lung when 
this organ is compressed upward by the fluid beneath it is often heard. 
During this stage of effusion blisters are often very useful in aiding 
in the absorption of the liquid which is present. 



PLEURODYNIA. 

This condition being one of intercostal neuralgia, should be treated 
according to the directions given under the heading of Neuralgia and 
Counter-irritation. 

PNEUMONIA. 

It is of the greatest importance that the physician should employ 
drugs in this disease at the proper stage, in the proper dose, and with 
definite ends in view. In the beginning of a pneumonia of the croup- 
ous type the state of the patient is utterly different, as a rule, from that 
of an individual attacked by the catarrhal form of this disease. The 
first generally attacks a person possessing sufficient vitality and force 
to cause him to suffer an acute inflammation of the tissues involved. 
In other words, the balance of health being destroyed, systemic dis- 
turbance is far greater than if less vital force was misdirected from its 
proper functions, and, as a consequence, high fever, with increased and 
excessive arterial tension, rapidly asserts itself, the changes in the cir- 
culatory system being produced both directly by the diseased processes 
and indirectly by the heat of the body acting as a stimulant to all its 
functions. In catarrhal pneumonia the systemic changes are, as a rule, 
somewhat different, since the patient is frequently already suffering 
from some predisposing disease, such as whooping-cough, bronchitis, 
measles, or similar affections. If the patient is in good condition, the 
fever and circulatory excitement of catarrhal pneumonia may be equal 
to that occurring in the croupous form; but even if this be so, there will 
always be found symptoms of lowered vitality which must modify the 
treatment in the early stages of the attack. For a clear and rational 
understanding of these conditions the reader should completely grasp 
the difference between them ; and under the title of Exhaustion and 



566 DISEASES. 

Depression the writer has already defined the differences between these 
states. 

It is important to emphasize that many diseases, taking pneumonia 
as an example, may be produced in two entirely different ways, or in 
two states of the system diametrically opposed to one another. On 
the one hand, we have a pneumonia attacking the lung of a strong and 
healthy individual who may be exposed to cold ; on the other, a pneu- 
monia may attack an invalid recovering from typhoid fever or other 
exhausting disease, such as any one of the exanthems or phthisis. 
The question of the presence of pneumonia is, of course, to be decided, 
but the state of the system is to be the guide in the treatment. In the 
perfectly healthy man who has pneumonia, exposure to cold upsets the 
normal balance, and the full force of his system runs riot and must be 
reduced to its proper level. In the weakly individual the curve of 
health has fallen below the normal line and must be raised until it is 
regained. In a sthenic pneumonia there are three stages of treatment : 
(1) The depressant or abortive stage, and, if this fails, (2) the suppor- 
tive, followed finally by (3) measures for the relief of the recovering 
lung in convalescence. In asthenic adynamic pneumonia we must 
omit all depressant treatment and resort at once to the second or sup- 
portive measures. The remarks which immediately follow, it is to 
be remembered, have only to do with the so-called first stage in sthenic 
cases. 

If the patient shows symptoms of weakness, as evidenced by the 
pulse and other sign-boards of disease, the treatment is to be consid- 
ered as that of the second stage. 

It should be remembered, however, that the mere fact that either 
stage of the disease is in existence should only lead to a most thorough 
study of the indications present. 

Primary Stage. — The primary stage of pneumonia consists in an 
increase in the calibre of a number of the bloodvessels of the lung, so 
that congestion occurs, and, as a result, the blood stagnates and an 
exudation finally ensues. We have, therefore, a state of the vascular 
system in which all the bloodvessels of the body are tense, except those 
which are relaxed by the inflammation in the lung, and the blood flow- 
ing in the direction of least resistance still further stagnates in and 
engorges the diseased area. All this occurs in the first stage, and it is 
the object of the physician so to decrease the over-pressure in the gen- 
eral system that the blood will leave the lung in order to obey the 
law of resistance which has originally caused it to accumulate in this 
locality. 

In those instances where the diseased process goes on still further 
into what is known as the second stage, or that of consolidation, the 
indications are at once reversed, and the change from the proper plan 
of treatment for the first stage to that necessary for the second may be 
required very promptly. The stagnation of the blood, combined with 
the pressure exerted by the rapidly forming exudate, not only narrows 
the patulous vessels by its pressure, but so prevents the expansile 
movements of the lung that proper pulmonary circulation cannot 



PNEUMONIA. 567 

occur. As a consequence the right side of the heart is distended at 
first and exhausted finally by the resistance offered to the blood-stream 
which it is forced to propel, and is simultaneously fed by blood which, 
by reason of the deficient respiration of the patient, is loaded with an 
excess of carbonic acid. Under these conditions the circulatory system 
must be so stimulated by the physician as to be able to overcome the 
obstruction. 

The methods which may be resorted to during the primary stage are 
very numerous, but there are only two which can be recognized as of 
great value, while the other procedures are but subordinate measures. 
These two measures are bleeding and the use of such drugs as our 
clinical and physiological knowledge tell us are proper. The discus- 
sion of bleeding as a therapeutic measure will be found on page 370, 
and it will readily be seen that the abstraction of blood from the entire 
system will rapidly relieve the diseased lung. The second, and by far 
the best method, is by the use of veratrum viride, aconite, or antimony, 
and perhaps several other drugs of a similar class. 

In adults veratrum viride will be found far more useful than 
aconite, while in most instances the reverse will hold true in children, 
in whom aconite always exercises a much more wholesome influence 
than any other drug of this class. Supposing that the disease be in 
the adult, let us for the moment consider why veratrum viride in this 
first stage is so useful a medicament. It will be remembered that the 
two alkaloids, jervine and veratroidine, possess different influences, 
and that between them they fulfil every object which is sought after. 
According to the experiments of Wood, jervine is a most powerful 
vasomotor depressant, relaxing to a remarkable degree the walls of the 
bloodvessels everywhere, and not only does it do this, but, at the same 
time, it so quiets the heart by an action upon its muscle or ganglia as 
to reduce its force, thus preventing engorgement of the lung, while 
veratroidine by stimulating the inhibitory nerves of the heart slows 
its beat, fills the ventricles by increasing their scope and the period of 
diastole, and allays excitement. 

Further recollection of physiological facts shows us that the blood- 
vessels of the abdomen are capable of holding all the blood in the 
body, and into these will flow the major portion of the fluid which 
is filling the pulmonary vessels, at once lowering blood-pressure very 
greatly everywhere, so that the lung is starved of blood without 
dangerous engorgement taking place in the abdomen. 

The manner of using veratrum viride is a good example of the 
necessity of careful physical diagnosis and a clear idea of what one 
is about to do. Used at the proper time and in the proper amount 
it is most useful, but when abused it is dangerous or disappointing, 
according to the carelessness of the physician. The following case, 
briefly described, is in point: A. E., aged twenty-five, brakeman, 
always strong and well, was much exposed to wind aud snow after 
having been thrown into a profuse sweat by coupling a large number 
of cars. He had a severe chill in the evening, ushered in by a cough 
and followed by fever and a sense of oppression with somewhat 



568 DISEASES. 

hurried breathing and pain in the side. At the time of admission 
into my wards, three hours after the chill, he had a temperature of 
103° F., the eyes were bright, the expression of the face slightly 
anxious. Physical examination showed exaggerated breathing over 
the entire right side, while at the base of the left lung posteriorly there 
was marked bronchial breathing and dulness on percussion. Fine 
rales could be heard now and then, but were not constant. The pulse 
was full and bounding. This man was at once given 3 drops of the 
tincture of veratrum viride every two hours until such a time as he 
complained of faint nausea, and his pulse was found to be no longer 
rapid and bounding, but soft and slow, while the skin was moist and 
relaxed. The sense of oppression disappeared, the expression of 
anxiety passed away, no pain was felt in the chest, and the attack was 
aborted. 

The employment of veratrum viride in this instance took place at a 
period in which it was possible to quiet the inflammation by " bleeding 
the man into his own vessels," or to reduce the hyperemia and con- 
gestion. If veratrum viride had been used later it would have done 
more harm than good, as we have already shown when discussing the 
state of the inflamed part at the commencement of the second stage, 
for the heart would then be laboring to push blood past the con- 
solidated area and the disease be fairly started or developed, and 
beyond the stage in which its abortion would be possible. 

The advantages of veratrum viride are its completeness and rapidity 
of action, the fact that it preserves in healthy bloodvessels the blood 
which may be needed in the struggle for life if the disease is not 
aborted, and lastly, its safety 1 is a point largely in its favor. 

The use of aconite in pneumonia is of particular value in children 
in whom the emetic effects of veratrum viride often prevent its being 
pushed to a sufficient degree to permit of an effect on the circulation. 
The indications for its employment are identical with those already 
named when speaking of the use of veratrum viride, and the only 
question which arises is as to whether its physiological action and 
clinical record justify its use. In reply to such a query the answer 
may be that it does act favorably in pneumonia, but that it is not as 
thorough in the case of adults as other drags. The studies of Ringer, 
Achscharumow, Boehm, and Wartmanu all prove that the drug is a 
distinct cardiac depressant, but there is no reliable evidence to prove that 
it exerts any vasomotor influence — the fall of arterial pressure, accord- 
ing to most writers, being produced only by the decreased action of 
the heart. On the other hand, there can be little doubt that clinically 
the arterial pressure is decreased by the drug. It at once becomes 
evident, however, that while its influence is for good in pneumonia, 
it does not possess the scope of action which makes it desirable in 
every case, and yet its powers of producing nervous quiet, allaying 

1 Both veratroidine and a resin contained in veratrum viride are powerful emetics,, 
so that upon the ingestion of a poisonous dose of the drug so much is generally vom- 
ited that recovery spontaneously occurs The symptoms produced are said to yield 
to treatment with remarkable readiness. 



PNEUMONIA. 569 

vomiting, or meeting some idiosyncrasy make it a drug always to be 
thought of in this disease. Antimony, although at one time used 
very largely in the treatment of pneumonia, has very properly ceased 
to be so commonly employed, chiefly for the reasons that it is a poison 
capable of producing decided morbid changes in the tissues, seeming 
to deprive them of their vital power for long periods of time, and 
that it often induces nausea of a distressing type, or even vomiting, 
before it can be pushed to a sufficient degree to cause the desired cir- 
culatory depression. Next to veratrum viride it holds a more useful 
position in extremely sthenic cases than any other drug, and may 
be used if the patient be unusually robust. Uniike aconite, which 
expends its chief action on the heart, this drug not only quiets and 
slows the pulse by an action exerted directly upon the heart muscle 
and its motor ganglia, but in addition markedly affects the vasomotor 
system, thereby aiding in causing the desired fall of arterial pressure. 
The proper dose of tartar emetic is -^ grain repeated every two hours 
until the skin shows moisture, nausea asserts itself, or the pulse gives 
evidence of sufficient relaxation. 

Gelsemiura has been highly recommended by Bartholow in the 
treatment of the early stages of pneumonia, but is certainly of very 
inferior influence, and is at the same time a dangerous drug. The 
use of chloral has been attempted, but its other powers so dominate 
its action on the circulation as to make it useless for the purpose 
before us. There can be little doubt of the value of pilocarpine in 
the very earliest stages of the malady. Given in full dose hypo- 
dermically it will produce so profuse a sweat and so great a lower- 
ing of arterial pressure as to relieve materially the congested lung. 
Its value, however, depends upon its very early employment, and it 
should not be used if any tendency to true consolidation has already 
asserted itself, as it is then useless and capable of depressing to a 
serious extent the heart, which is about to undergo a severe struggle 
with the engorged lung. 

The application of cold to the chest in the early stages of pneu- 
monia has been resorted to very largely in Germany by Liebermeister, 
Niemeyer, and others. It is said that the dyspnoea is decreased at 
once, and the pain lessened.' Bartol and Ziemssen speak of it highly 
in the croupous pneumonia of children, but the writer would fear to 
use it in any case, unless the patient was above puberty and very 
strong. (See Cold.) 

If cold is used it should be employed as an ice-poultice made of 
cracked ice and sawdust, mixed and sewed up tight in an oil-silk 
bag in such a way as to prevent the bed and clothes from becoming 
wet. (See page 344.) At this period, too, very distinct effects can 
be exercised over the bloodvessels of the lung by irritation of the 
skin, which results in the reflex influence already spoken of under 
Counter-irritation. 

The most active means of producing this counter-irritation is 
by the use of the dry cup. The wet cup may be used to deplete or 
bleed the patient at the same time that it acts as a counter-irritant r 



570 DISEASES. 

but in many instances the dry cup will suffice. If the counter-irri- 
tation is to be thorough the cups should be applied to the number of 
five or six, scattered over the area involved and a little to the sides 
of the diseased patch. 

Mustard may be employed and a turpentine stupe (see Turpentine) 
or Cayenne pepper can be used as counter-irritants. The latter is at 
once one of the most efficient and least dangerous irritants, as it pro- 
duces much reddening and irritation, but does not destroy or burn 
the skin. In the beginning of a pneumonia a blister should be applied 
not immediately over the congestion, but a little to one side, as it 
may increase the congestion if placed over the diseased spot. When 
resolution begins, the blister may be placed over the exact spot in- 
volved, to aid reparative changes. 

The treatment of the second stage of pneumonia, when of a sthenic 
type, is much more difficult and hazardous than the treatment of the 
first stage. The question as to the line separating the first from the 
second stage must be clearly answered in the physician's mind, and 
distinct indications must exist for the employment of measures suited 
to the disease at this period of its development. The physical signs 
in the chest are only of value as evidencing the progress of the local 
disease process, and only indirectly indicate the use of a given line 
of treatment, while the state of the pulse, the color of the skin, more 
particularly of the face, the duskiness of the nails along with the 
rhythm of the respirations, tell the physician how the patient is 
standing the strain. This is not the place to discuss the possible 
causes of death under these conditions, but to indicate clearly what 
is to be done when the flagging, to-and-fro pulse indicates arterial 
starvation, and the dusky skin and pulsating jugulars show venous 
engorgement and distention of the right side of the heart. The 
employment of digitalis is here of the greatest service. It should 
be given in 5-drop doses of the tincture every four hours, and be 
accompanied by -^ of a grain of strychnine three times a day, or 
oftener, as the case may require. If the digitalis is carelessly given, 
and its effects are not watched, it may be found to produce so rapid 
and irregular a pulse at the wrist as to give one the impression that 
the heart needs still further doses of the drug, but if the ear be 
placed over the prsecordium under such circumstances the violent 
apex beat, diffused thrill, and accentuated heart-sounds will show that 
this viscus is over-stimulated, and that the drug should be withdrawn 
until some hours have elapsed, and its need is evidenced by a condition 
of real cardiac en feeble in eut following a stage of marked improvement 
due to the temporary withdrawal of the drug. 

Having recommended these drugs in these states, let us study why 
they do good and the reasons for their use. According to a mass of 
experimental evidence, which by its very volume is incontestable, 
digitalis acts upon the heart muscle as a most powerful stimulant, 
increasing the force of contraction in the cardiac walls and driving 
the contents of the ventricles out into the pulmonary artery and aorta 
with an unmistakable increase in arterial tension. The experiments 



PNEUMONIA. 571 

of Boehm show that the heart actually does more work under 
digitalis, and these studies have been confirmed by Williams. Fran- 
cois Frank agrees with Williams in the belief that this increased 
force is due to improved tone of the cardiac muscle. These facts 
indicate the raison dJetre of the use of digitalis in the second stage of 
pneumonia, siuce it enables the right side of the heart to send the 
venous blood to the general arterial system, thus preventing the over- 
distention of the right ventricle. When we remember, on the one 
hand, that all muscular fibres rapidly become paralyzed by over-dis- 
tention, and, on the other, that digitalis produces a systolic contraction 
of extreme completeness, we can readily see how, by the entire empty- 
ing of the ventricle at each contraction, distention from gradual ac- 
cumulation is impossible. It seems probable, too, that the pneu- 
mogastric nerves are the trophic nerves of the heart, and that in 
consequence its nourishment is improved by their stimulation by the 
digitalis. (See articles on Heart Disease and Digitalis.) 

There are other reasons, however, why digitalis should be used at 
this time, which are only second to those just named. The heart-beat 
under its influence is greatly slowed, and by means of this slowing 
becomes a cool-headed man instead of a flurried, nervous, irritable 
invalid. By its very slowing it finds time to carry out all its func- 
tions regularly, and with " all its might," it does not exhaust itself 
by fruitless effort, and accomplishes far more than when it is irregular, 
and uncertain as to whether it is to contract or expand. That digitalis 
slows the pulse by a stimulation of the pneumogastric nerves has 
been proved beyond all doubt, and the remembrance of the fact that 
these nerves are respiratory in function as well as' cardiac, clearly in- 
dicates the value of this influence. They supply motor fibres to the 
muscular coats of the entire bronchial system, the tonicity of which is 
most important for the well-being of the lung, since by this means 
the quantity of air admitted to the vesicles is equalized aud the ex- 
cessive use of the healthy vesicles prevented. Longet asserts that the 
" lung tonus " during increased tension (which is present during 
pneumonia) depends solely upon these muscles and their proper nerve 
supply. These assertions are once more supported by the experiments 
of Graham Brown and Roy, which prove that the vagal filaments are 
to the lung and its air streams what the vasomotor nerves are to the 
circulatory system, dilating or contracting the bronchial tubes as may 
be necessary. Digitalis by stimulating them increases their tone and 
supports them when strained. The assertion of Schiff, that the 
vagus is the vasomotor nerve of the lungs, is only partly true, and is 
so doubtful as to prevent any value being derived from this fact, so 
far as the blood-supply is concerned. Another way in which digitalis 
does good is often overlooked. The respiratory centre is governed 
solely by the condition of the blood. If this fluid be overladen with 
carbon dioxide it sends out more impulses and rids itself of the gas 
by the increased respiratory effort ; or, if an excess of oxygen is 
present, it sends out fewer impulses until the normal balance is re- 
stored. If, however, the carbon dioxide is not rapidly eliminated the 



572 DISEASES. 

combined effect of the gas and effort speedily decrease the respiratory 
activity. It is also to be remembered that Marckwald has proved 
that the pneumogastric nerves are the regulators of the impulses sent 
out by the respiratory centre, so that a perfect rhythm is obtained. 
The asphyxia due to the laming of a lung by pneumonia increases 
the number of respiratory efforts, and in consequence the labor 
of the vagus is increased. Very commonly we see cases of pneu- 
monia in which the breathing is hobbling, with a distinctly altered 
rhythm — now fast, now slow ; now full, now deep. In these the 
breathing becomes regular and quiet after digitalis is used in the 
proper amount, a result often accorded to the cardiac influence of the 
drug, but largely due to its effects on the respiratory portion of the 
vagus nerves. The same advantages are gained by a regulated re- 
spiratory effort on the part of the lungs as are obtained in the case of 
the steadied heart. 

In those cases where digitalis is pushed too far, these favorable 
effects are replaced by the most unfavorable conditions, as has already 
been described in the discussion of the action of this drug in heart 
disease. Here, as elsewhere, over-stimulation is as bad as lack of 
proper tone. 

Strychnine is used to carry out au object supplementary to that of 
digitalis, for it has been proved to be one of the most reliable and 
powerful stimulants upon the respiratory centres that we have, and 
they are apt to be exhausted by rapid breathing. It also prevents 
general nervous depression and aids in the maiuteuance of a circula- 
tory balance by its stimulating effect on the vasomotor system and 
heart muscle. 

The employment of alcohol in the second stage of pneumonia is 
based upon the same principle as is the use of digitalis. It is inferior 
to the latter drug because it stimulates the heart and increases its 
force but does not afford it the nutrition that digitalis can give it. 
That is to say, it stimulates and causes the expenditure of all the 
power the heart is capable of, but does not replace the tissue destroyed 
by the effort. Further than this, it possesses the disadvantage of act- 
ing for a comparatively short time, dose for dose, and tending to cause 
cerebral excitement or heaviness if it is pushed to the point of stimu- 
lation required by the circulatory condition. In persons addicted to 
the excessive use of alcohol it either fails to act, produces effects con- 
trary of those desired, or actually aids the disease process. The 
danger of the patient forming the alcoholic habit is also to be remem- 
bered. 

Having detailed this treatment of the second stage, that for the 

third stage is to be considered. For the thorough understanding of 

this we should remember that this stage consists in the breaking down 

. . . 

or resolution of the exudations and in their absorption and expulsion 

from the chest. 

At this time the entire diseased area is crowded with secretions 
which have been formed, dead epithelial cells, and all the morbid sub- 
stances which have accumulated. The local surfaces are depressed by 



PNEUMONIA. 573 

the reaction following upon the excitement of inflammation, and their 
tone is below par. The object of the physician must be to stimulate 
these areas so that they may throw off the old and take on a new 
functional activity, and for this purpose remedies are to be used which 
will soften deposits and stimulate depressed vesicles and bronchial tubes 

By far the most valuable class of drugs to be here employed are 
those which will increase the secretions from mucous membranes 
without acting as cardiac depressants. Antimony is a remarkable 
drug for the production of a large secretion, but is often too depress- 
ing to the heart after the prolonged strain to which it has been sub- 
jected. Under the article on Bronchitis the action of these drugs will 
be found more thoroughly explained, but it will suffice to point out, 
at this time, the method of their administration. 

First and foremost stands the chloride of ammonium, a drug whose 
elimination takes place largely through the lungs, and which acts most 
happily in aiding in the loosening of the cough and secretions. Its 
only disadvantage is its salty taste, which in many cases renders it 
disagreeable to the patient, while its irritant properties may disorder 
the action of the stomach, although if this organ is depressed and 
atonic this drug often improves its condition. The drug may be given 
in compressed pills, or what is far better, in such a mixture as here 
follows : 

I£. — Ammonii chloridi ^ij. 

Extract, glycyrrhizse fl £ij 

Aquae dest . f^iij- M. 

S. — Teaspoonful in water every four hours during the day. 

If the cough be in excess of the expectoration, that is, if the cough 
often fails to bring up phlegm and is due to tickling or irritation, it 
may be relieved by the addition of a little morphine to this mixture, 
as follows : 

I^. — Morphinae sulph. . . . gr. j vol gr. ij . 

Ammonii chloridi . 3ij- 

Extract, glycyrrhizse fl £iv. 

Aquae dest. f|> v j- M. 

S. — Dessertspoonful every four hours. 

If much more morphine than this is used it will tend to stop 
secretion. 

When the chloride of ammonium fails to act favorably, the car- 
bonate may be called into use for its local and circulatory action, and, 
in addition, the bromide of ammonium may be employed to allay the 
cough if morphine cannot be used. The following prescription is 
valuable : 



M. 





R . — Ammonii chlorid. 


• 3J- 




Ammonii bromid. 


• 3J. 




Ammonii carbonat. 


• 3J- 




Extract, glycyrrhizae fl. 


• 3 "J 




Aquae dest. .... 


• • fgxj. 


s.- 


—Dessertspoonful every four hours. 





For other remedies for this stage, see Bronchitis. 



574 DISEASES. 

So far, the treatment given has dealt with a routine ease ; let us 
suppose that things run less smoothly and complications arise. It 
will be impossible, in a book on Therapeutics, to explain the causes 
of all the dangers which may present themselves ; one of the most 
common of these is an increase in the area of the consolidation or its 
development elsewhere, or, in other words, a second attack super- 
imposed on the first. The treatment of this most dangerous state 
of affairs requires the greatest care, skill, and intelligence, and con- 
sists primarily, not in the use of cardiac sedatives, but in the admin- 
istration of digitalis and stimulants, in order to drive out the blood 
from the new congestion, or to enable the system to bear the strain. 
A blister or dry or wet cup thoroughly applied a little to one side of 
the spot involved, may aid in the removal of the congestion, and the 
application of mustard plasters to the feet is indicated, or a turpentine 
stupe may be applied to the entire chest. The use of expectorants 
stimulating to the lungs is to be stopped at once, and nourishment 
given in small amounts, carefully prepared, and frequently adminis- 
tered. It is to be remembered, however, that above all things the 
physician must use his judgment, and if he finds that sufficient 
strength yet remains to his patient for the second attack to partake 
of a dynamic or sthenic character similar to that of the first he must 
use bleeding, leeching, cupping, or cardiac sedatives. 

If the consolidation be very widespread in any case, the entire 
heart becomes strained by the venous congestion and arterial tension, 
due to the partial asphyxia, while there is also danger of death from 
lack of oxidizing space for the blood. No better treatment exists, 
under these circumstances, than the inhalation of oxygen, either 
almost pure or mixed with air. By this means even a small patch of 
lung offers sufficient oxygen to the blood to cause its necessary oxida- 
tion. Th : s gas may be obtained in small cylinders, which, by com- 
pression of the gas, hold forty gallons, at several large establishments, 
notably at the offices of the S. S. White Dental Company, which has 
agencies in. all the large cities of the United States, or it may be made 
by the physician himself in the following manner: Take 4 ounces of 
chlorate of potassium — which must not contain a single chip or piece 
of organic matter — and add to it an equal quantity of peroxide of 
manganese. These should be placed in a retort or strong flask, and 
an alcohol-lamp placed under it. The gas as it is generated escapes 
through a tube, which should pass into a large jar of water, so that 
the gas, as it bubbles up, may become cooled and purified ; a second 
tube may now lead the gas to an inhaler over the patient's mouth. It 
should be remembered, however, that chlorate of potassium may ex- 
plode if contaminated by the smallest piece of organic matter. 1 

The period in the treatment of pneumonia when simple poultices 
do the greatest service, and the only time when they are to be em- 
ployed for valid reasons, is during the second and third stages of the 

1 Several firms manufacture small yet complete forms of apparatus for the manu- 
facture and clinical application of oxygen. The cost varies from $25 to $50. 



PRURITUS. 575 

disease, when clinical experience shows that they are of value in aid- 
ing in the production of resolution and in loosening the cough. How 
they act, except by increasing the external warmth and moisture of 
the parts, we do not know, unless by the production of some reflex 
influence exerted upon the lungs from the skin by means of the 
nerves. Unless the attendant is unusually intelligent and well trained, 
the common poultice does more harm than good, because it is allowed 
to get cold, or the patient is chilled when it is changed. The proper 
application is the cotton and oiled-silk jacket, particularly in young 
and restless children. 

The remarks which have just been made deal entirely with simple 
poultices, and not with those possessing drugs in their mass, such as 
those agents belonging to the counter-irritant group of drugs. By far 
the most commonly used substance under these circumstances is mus- 
tard, and its addition to the mass at once allows this method of treat- 
ment to be employed in the first as well as in the later stages. 

PRURITUS. 

Itching of the skin or mucous membranes about the openings of the 
body is a very common state, and while it may be dependent upon local 
causes, such as lice or fleas, it more commonly is due to some systemic 
condition, such as debility, diabetes, albuminuria, or other similar 
causes. The treatment consists, first, in the removal of the cause, and, 
next, in the local treatment of the condition. There is generally no 
redness or eruption, except that due to scratching. 

Internally, arsenic, quinine, bitter tonics, cod-liver oil, alkaline 
diuretics, or mineral waters are useful in debilitated cases, and an 
avoidance of condiments, such as mustard or pepper, is needful if the 
disease affects the mouth of the urethra or vagina. 

The local treatment of pruritus consists in the use of lotions, salves, 
or ointments made up of various constituents, a number of which are 
capable of acting as local anaesthetics. Very often, bathing the parts 
with 1 drachm of bicarbonate of sodium or of borax to a pint of cold 
water gives relief temporarily, or the following formulae will be of 
service : 

& .— Acidi carbolici .... f £j vel f ^ij. 

Aquse dest q. s. ad Oj. M. 

S. — Apply as a lotion several times a day. 

K. — Liquor, carbon, detergen. 1 131J. 

Aquse q. s. ad Oj. M. 

S. — Apply as a lotion. 

Or an ointment made as follows is serviceable : 

R .—Acidi carbolici .... gtt. v vel xx. 

Adipis benzoinatis 3j. 

Petrolati 3J- M - 

S. — Apply as an ointment. 

1 For method of preparing this liquor, see 457. 



576 DISEASES. 

Iii other cases 10 to 20 minims of chloroform may be used in place 
of the carbolic acid. 

Cocaine may be painted over the parts, but it should rarely be used 
in ointment, as fats prevent its acting effectively. It should also be 
remembered that the anal and vaginal mucous membranes are so thick 
that strong solutions of cocaine are necessary to produce anaesthesia 
and that the effects of cocaine are only temporary. Where the itching 
is very obstinate the parts may be painted with a solution of nitrate 
of silver of the strength of 20 grains to the ounce of water, cocaine 
having been previously applied to relieve the pain of the application. 
(See article on Cold.) Brinton has highly recommended teucrium 
scordium in the dose of 20 grains three times a day. 



PUERPERAL DISEASES. 

The diseases of the puerperium may be divided into two broad 
classes — infectious and non-infectious. The first class should be 
further subdivided into (1) those infectious diseases in which the point 
of infection has been somewhere along the parturient tract, and (2) 
those in which the infectiug poison has entered the body by some other 
channel. Under sub-heading 1 come all those diseased conditions, 
grouped together under the very inadequate generic terms " puerperal 
fever," "puerperal septicaemia," "puerperal infection," and the like, 
none of which truly express the condition present. If it is necessary in 
medical nomenclature to have a single term which shall denote infec- 
tion of the genitalia after delivery, a word should be coined strictly 
limited in sense to mean the pathological conditions which result from 
the activity of pathogenic microbes along the whole genital tract. 
This classification is necessary for a clear and systematic description 
of the treatment of diseases in the puerperal state. 

The Treatment of Infection along the Genital Tract after Labor. — 
By far the most common form of infection along the genital tract after 
labor is the absorption of ptomaines from the infection and decomposi- 
tion of membranes, fragments of placenta or blood within the uterus. 
This coudition will be found in more than 75 per cent, of all cases in 
which infection occurs. Therefore, in any case, after labor, in which 
there is fever that cannot be explained by some evident cause inde- 
pendent of the genitalia, it is safe to assume ptomaine poisoning and 
to act accordingly. The indications are plain : to destroy the microbes 
and thus at once stop the manufacture of their poisonous products, 
and, if necessary, to remove their habitat. 

The writer's routine application of this principle in practice is as 
follows : If the temperature after delivery remains over 100° for 
twenty-four hours without evident cause independent of the genitalia, 
he washes out the uterine cavity with at least 1 quart either of 
bichloride of mercury solution, 1 : 2000, or a 2 per cent, solution of 
creolin. The former is more convenient in private practice because 
the tablets of corrosive sublimate can be easily carried about in one's 



PUERPERAL DISEASES. 577 

instrument bag. To insure the entrance of the antiseptic fluid to 
the fundus and its free exit from the cervical canal, an intra-uterine 
catheter is desirable. Of all those upon the market, the best is that 
manufactured by Lentz, an instrument-maker of Philadelphia. If, 
however, the cervical canal is patulous, as it usually is after labor, a 
hard rubber catheter attached to a Davidson's or fountain syringe 
answers the purpose perfectly. 

In the majority of cases this treatment will bring the temperature 
down to normal within twenty-four hours. If fever does not dis- 
appear within this time, or perhaps rises even higher, the second 
indication must be met. The infected albuminous substance within 
the uterine cavity must be removed in order to deprive the micro- 
organisms of their feeding-ground. This is best accomplished by the 
use of the curette and the placental forceps, care being taken in the 
employment of the former instrument to guard the uterine wall itself 
from the slightest injury, for not only can the uterine muscle be per- 
forated by a curette in clumsy hands, but slight wounds of the uterine 
substance with this instrument may be enough to inoculate the general 
system with the germs whose activity has been confined before to the 
uterine cavity. 

The writer's manner of employing this plan of treatment after 
labor is as follows : 

The anterior lip of the cervix is seized with a double tenaculum 
and pulled gently downward ; a cleansing uterine douche is then 
given in order to disinfect the field of operation ; next the curette is 
inserted to the fundus, and the whole interior of the uterus is carefully 
gone over with the instrument. First the fundus and then each of the 
four sides ; then the curette is turned with the scraping surface upward 
and withdrawn from the cervical canal, a finger in the vagina meeting 
its tip as it emerges in order to help extract any substance which may 
be caught by and entangled in it. 

Next the placental forceps is inserted and an effort made to grasp 
any material lying loose within the cavity or still attached to the 
uterine walls. It is usually best to repeat each of these manoeuvres 
several times until nothing more can be brought away except a little 
clear blood. 

Then the uterine cavity is again thoroughly washed out. The 
writer has many temperature charts in his possession which show 
the success of this treatment, when simple uterine irrigation has 
failed. Occasionally it is necessary to repeat the irrigation, and even 
the curetting, for several successive days. If, as rarely happens, 
this treatment should prove unsuccessful and the temperature should 
remain elevated in spite of irrigation and the use of the curette and 
placental forceps, one must assume either that general systemic infec- 
tion has occurred, or, at least, that an inflammatory action has begun 
in the uterine walls or within the tract of the tubes. One of the ear- 
liest, surest signs of systemic invasion is the appearance of peritonitis. 

In such a case the only available treatment is to support the body- 
cells in the combat which they must wage with the invading micro- 

37 



578 DISEASES. 

organisms. This is best accomplished by the administration of as 
large a quantity of nutriment as the patient can stand without re- 
bellion of the stomach or bowels, and the exhibition of a large quan- 
tity of alcoholic stimulant. Cases of this sort not infrequently require 
more than a pint of whiskey or brandy in the twenty-four hours. 
Occasionally measures will be required to reduce an exaggerated ele- 
vation of the temperature, but this is best avoided as long as possible, 
for antipyretic treatment is usually depressing and ill suited to the 
patient's adynamic condition. 

With this plan of treatment, about three-quarters of the cases of 
general septic infection after labor will recover. There may be some 
in Avhich metastasis to important organs occurs so early as to render 
all treatment of no avail. There will be others in which the peri- 
toneum is early infected, and in which the septic peritonitis develops 
rapidly and to an extensive degree. It is in such cases that laparotomy 
and evacuation of the septic matter, usually pus, within the peri- 
toneum will occasionally save life. The physician must guard him- 
self, however, from the disposition which is prevalent at this day, to 
operate too early and unnecessarily. After operation, drainage of the 
peritoneal cavity is an essential feature of the treatment, even although 
the evidence of suppuration within the cavity is slight. The writer 
has in mind a case in which an operation was performed ten days post- 
partum, for septic peritonitis ; a very small quantity of purulent lymph 
was found upon one ovary, which was greatly enlarged and contained 
a small quantity of sero-pus. The ovary was removed and the abdo- 
men closed without drainage, as there was no other evidence of suppu- 
ration within it. Thirty-six hours later the patient died, and the 
peritoneal cavity was found filled with pus which had accumulated in 
that short space of time. In the early stages of the peritoneal infec- 
tion, if the subject is vigorous, not exhausted by a prolonged labor or 
other depressing causes, the administration of saline purgatives in con- 
centrated solution will often effect brilliant results. 

The writer's custom is to give a dessertspoonful of a concentrated 
solution of Epsom salts every fifteen minutes until free evacuation of 
the bowels is secured. He has seen the temperature reduced by this 
plan of treatment from 104° to normal, in the course of twelve hours, 
and with the reduction of temperature all the symptoms of peritonitis, 
which were well marked, entirely disappeared. In the treatment of 
microbic activity along the parturient tract after labor, it should never 
be forgotten that the point by which the microbes invade the system 
may be anywhere from the fundus of the uterus to the parturient out- 
let, therefore the practitioner should never neglect to examine care- 
fully all the lower parturient tract, in order to detect, if possible, an 
ulcerated surface covered by diphtheritic membrane, which if over- 
looked might be the entrance-point for a fatal infection. These un- 
healthy surfaces are best detected by the use of a cylindrical speculum 
of clouded glass introduced so that the cervix appears within its inner 
end and then withdrawn, so that the vaginal mucous membrane as it 
prolapses into the end of the speculum may be examined, and treated 



PUERPERAL DISEASES. 579 

if necessary throughout its whole extent. If au unhealthy, ulcerated 
wound is thus discovered, the writer's practice is to apply to it a solu- 
tion of nitrate of silver 40 or 60 grains to the ounce. In the vast 
majority of cases this application will promote an exfoliation of the 
unhealthy membrane, and the appearance of healthy granulation tissue 
within a few days. 

It may, iu some cases, be necessary to employ a stronger applica- 
tion, as the solutiou of chloride of zinc, but the writer has not been 
driveu to its use. The most common point of infection outside the 
parturient tract after labor is some portion of the urinary apparatus, 
almost invariably the bladder. The process of parturition necessarily 
diminishes the vitality of the vesical mucous membrane cells by the 
pressure and stretching to which they are subjected. After labor, 
therefore, they are not in a condition to resist the attacks of micro- 
organisms, should these in any way gain access to the vesical cavity. 
Most commonly microbes are introduced into the bladder by a cath- 
eter. This, however, is not necessary, as it has been plainly demon- 
strated that they can wander from the vaginal canal through the 
urethra into the bladder without the intervention of an, instrument 
which, would directly carry them into the vesical cavity and deposit 
them in that situation. Once arrived within the bladder the microbes 
attack the depressed bladder cells, and very often gain a lodgement 
in the vesical mucous membrane. This is manifested by the usual 
symptoms of septic cystitis, fever, pus in the urine, pain on pressure 
over the hypogastrium, and pain and difficulty in micturition. The 
duration of these symptoms is, as a rule, not very long. The fever 
subsides, and the symptoms of cystitis disappear. After an interval 
of some days, however, there is again a sharp outbreak of fever, with 
pain in the region of the kidneys, and the reappearance of pus, or at 
least of numerous microbes in the urine. This indicates a septic in- 
fection of the pelves of the kidneys after the microorganisms have 
migrated along the ureters. During their migration their presence has 
not been manifested by any symptoms. In the majority of cases even 
the symptoms of pyelitis will disappear after a time, and the patient 
will make a good recovery ; but in a certain proportion there is a 
systemic infection by the direct passage of microbes or their products 
from the kidneys into the blood. There may be an extensive suppu- 
ration of the kidneys and surrounding tissue, with fatal results, or, as 
the writer has seen in several cases, the symptoms of general systemic 
infection become so grave as for a long time to threaten the patient's 
life. In the worse cases of bladder infection the mucous lining 
sloughs, peritonitis develops, and the patient dies before the disease 
has time to spread to the kidneys. 

The practitioner, bearing in mind the serious consequences of septic 
cystitis after labor, should always be on the watch for it, and should 
adopt, immediately upon its discovery, an energetic treatment. A 
thorough disinfection of the bladder will remove all present symp- 
toms, and prevent the occurrence of grave and possibly fatal after- 
complications. To accomplish this purpose the writer employs a one- 



580 DISEASES. 

half of one per cent, solution of creolin. One injection of a quart of 
this solution through a two-way catheter is usually sufficient. Occa- 
sionally it is necessary to repeat it, or to follow it by several injections 
of boric acid solution. In susceptible individuals creolin causes too 
much pain to be employed. A 1 to 8000 bichloride of mercury solu- 
tion may be substituted for it, or, in mild cases, a solution of boric 
acid alone will be sufficient. 

If, in spite of all precautions, infection of the kidneys should ensue, 
a vigorously stimulating and supportive plan of treatment affords the 
only hope of success. If extensive suppuration occurs in the kidneys, 
all treatment will, of course, be useless. 

Perhaps the most uncommon point of septic infection after labor is 
the rectum. The writer has, however, seen one fatal case of this sort 
— from the use, no doubt, of a dirty syringe-nozzle in the hands of a 
careless nurse. It would be difficult, or perhaps impossible, to diag- 
nosticate such a case until after death, and, therefore, treatment 
directed toward this form of infection will usually not be adopted. 

Next in frequency to the parturient tract and the uriuary system as 
a region of ^infection after labor come the breasts. Infection of the 
nipples, and a consequent mammary inflammation, or suppuration, is 
one of the most troublesome minor complications that the obstetrician 
is called upon to treat. By careful preparation of the nipple during 
the last month of pregnancy, and by extreme care to secure perfect 
cleanliness during the period of lactation, infection of the breasts can 
almost surely be avoided. If it occurs, the first effort should be to 
limit its extent and degree, and to prevent, if possible, suppuration. 
The best means to accomplish this end are derivation of the blood 
from the mammary glands by an active purge, compression of the 
gland- substance, and support of the breasts by a suitable mammary 
binder. 

To these should be added, in the acute stage of inflammation, fomen- 
tations of very hot water, and, later, the application of cloths wrung 
out in lead-water and laudanum, renewed every three hours. Unless 
the infection has been of a virulent nature, and the amount of infective 
material large, this plan of treatment will almost surely dissipate the 
inflammation and prevent suppuration. 

The other infectious fevers of the puerperal state include the infec- 
tious diseases which can, under any circumstances, attack the adult 
female, and their treatment differs in no respect during the puerperium 
from that adopted under ordinary circumstances, unless there should 
be developed some local complications. 

Non-infectious Diseases of the Puerperium. 

Anomalies of Involution. — Super-involution, an exaggeration of that 
process by which the uterus is reduced to its normal size after labor, 
only manifests itself, as a rule, after the puerperal state is completed, 
and, therefore, its treatment need not be further considered. 

Subinvolution, an arrested or retarded return of the uterus to its 



PUERPERAL DISEASES. 581 

normal condition and dimensions after labor, is one of the commonest 
complications with which the obstetrician has to deal in the manage- 
ment of the pnerperinm. The cause of subinvolution is always a local 
one. General conditions, as acute fevers and so on, have no influence 
whatever upon the process of involution unless they are accompanied 
by some local complication. 

There are two causes which prevent the involution of the uterus 
which must be borne in mind when one is called upon to treat this 
condition. The involution may be prevented, on the one hand, by 
anything which calls an excessive amount of blood to the uterine 
body, as, for instance, small fibroids within its walls or hypertrophied 
deciduous membrane remaining adherent to its inner surface. On the 
other hand, subinvolution may be the result of mechanical obstruction 
to the contraction of the uterine walls and the reduction of its cavity 
to the normal size. As an example of this we have a retained placenta 
or a submucous fibroid or adhesions dragging the uterus out of place 
and preventing its contraction, or most commonly, perhaps, an over- 
distended bladder and rectum. 

In those conditions which result in a hyperemia of the uterus the 
cause of an excessive blood-supply must be sought out and removed 
before one can remedy the subinvolution. 

If small fibroids can be detected, the administration of quinine, 
ergot, and strychnine, in pill form, has been found most useful. If 
practical, a faradic current may be employed in addition to medication. 
If there is a hypertrophied endometrium retained within the uterus a 
curette will most quickly and effectually hasten involution. In cases 
of heart disease in which the blood-current is sluggish and dammed 
back into the large veins of the trunk, digitalis will be the most effec- 
tive remedy to overcome the subinvolution. There may be an active 
hyperemia associated with inflammatory action, either in the uterine 
wall or upon its peritoneal covering or in its annexa ; in this case the 
inflammation must be overcome by disinfection, the use of purgatives, 
and, possibly, the local application of hot water, before involution can 
be secured. When there is mechanical obstruction to the return of 
the womb to its normal dimensions the hindrance must, of course, be 
removed before one can expect a good result from treatment. In the 
case of retained adherent placenta every effort must be made to re- 
move the placental tissue. In the case of submucous fibroids their 
removal must be attempted if there is any hope of safely accomplish- 
ing it. 

There is no case of labor which does not leave behind, in the par- 
turient tract, some injury to the maternal structures. Usually these 
are slight in degree, manifesting no symptoms and healing spontane- 
ously. Occasionally the injury done results in fistula, communicating 
with the bladder or rectum, in deep grauulating wounds in the vagina, 
or in ulcerated sores. 

In the case of fistula a cure can sometimes be effected without oper- 
ative interference by touching up the edges of the fistulous tract with 
nitric acid, in order to excite an outpouring of granulation tissue in 



582 DISEASES. 

the hope that it may plug up the opening. In deep tears, which have 
not been primarily united, application of a solution of nitrate of silver 
will hasten the cure and prevent infection of the wounded surface. It 
ulceration occurs, the ulcerated spots are to be carefully watched and 
treated in the same manner. 

Hemorrhages from the birth-canal after labor depend upon a num- 
ber of well-known causes, which must be sought out and corrected 
before the bleeding will cease. Most frequently, the cause of a haein- 
orrhage will be found in retained placental fragments in utero, which 
must be removed. Not infrequently, displacements of the uterus will 
be found as a cause, and correction of the displacement will stop the 
bleeding. 

In interstitial bleeding, after labor, resulting in hsematoma, care 
must be taken to preserve the parts in as aseptic a condition as possi- 
ble, while an attempt is made to limit the bleeding by the application 
of direct cold, preferably by means of a Barnes bag dilated with ice- 
water, which must be removed from time to time in order to allow the 
lochia to escape. After rupture or incision of these blood tumors the 
cavity left behind must he carefully disinfected with the bichloride of 
mercury solution or creolin, and, if necessary to control further bleed- 
ing, well packed with iodoform gauze. 

Of all forms of bleeding, that which occurs directly after labor, in 
consequence of inertia uteri, known as post-partum haemorrhage, is the 
most frequent of occurrence, and the most alarming and dangerous in 
its manifestations and consequences. No one should attend a case of 
obstetrics without having in mind a clearly-defined programme to be 
put in immediate execution when called upon to deal with this frequent 
and dangerous complication. There are two indications to be met. 
First, to control the haemorrhage, and, second, to treat the after-condi- 
tion The first indication is met by the following plan of treatment: 

External stimulation of the uterus by kneading and rubbing through 
abdominal walls, as is practised in Crede's method of expressing the 
placenta. 

Next carry the other hand into the uterus and remove any blood- 
clots, pieces of placenta, or membrane that may be found there, so that 
the internal surface of the uterine walls is irritated by the movements 
of the operator's fingers. 

Next apply a small piece of ice upon the abdomen externally and 
carry another piece the size of a hen's egg into the uterine cavity. The 
use of cold must not be persisted in for more than a minute at most, for 
its ultimate action is depressing and relaxing. 

Next soak a clean linen handkerchief in vinegar, carry it up to the 
fundus and squeeze it out so that the vinegar shall run down over the 
uterine surface. 

Next, hot water at a temperature of 116° or 120° should be injected 
into the uterine cavity. 

If one happens to have the necessary appliances at hand (a small 
Gaiffe battery, which can be carried in an ordinary iustrument-bag), a 
strong faradic current can be applied to the uterine muscle. 



PUERPERAL DISEASES. 583 

Finally, as a last resort, the uterine cavity may be packed with long 
strips of iodoform gauze in the manner suggested by Diihrssen and 
carried out by a number of observers with gratifying success. 

Drugs, as the styptic salts of iron, and especially Monsel's solution, 
have been recommended from time to time as intra-uterme applications 
in the case of post-partum haemorrhage, but they are dangerous, for 
the coagulation produced by them may extend far into the uterine 
vessels, and the clots must be broken up by putrefaction, exposing the 
patient to the danger of septic poisoning. 

This programme is to be carried out in the order given ; if the 
milder measures suffice, of course the more radical plans of treatment 
will not be employed. Excessive haemorrhage (post-partum) from 
lacerations along the genital canal can be controlled by well-placed 
sutures. 

Bearing in mind this plan of treatment, it is almost inconceivable 
that an intelligent and skilful practitioner should lose a case of post- 
partum haemorrhage. 

The physician should give ergot in full dose by the mouth, and, if 
need be, hypodermically. 

Treatment of the After-condition — While the physician is busy con- 
trolling the haemorrhage, the nurse should admiuister a hypodermic 
injection of ether, if symptoms of shock or collapse are manifested. 
After the bleeding has ceased it is well to administer an enema of a 
pint of hot water, which maintains the patient's temperature, relieves 
the shock and by its irritation promotes contraction of the uterine 
muscle. This should be succeeded by small doses of hot, strong 
brandy-and-water, and a little warm milk if the stomach will retain 
it. As soon as reaction is well established, a half-pint of hot beef-tea 
should be administered and a hypodermic of J grain of morphine 
given in order to secure quiet and rest and to get the stimulant quali- 
ties which this drug undoubtedly possesses. Occasionally measures 
must be adopted to retain enough blood within the large vessels and 
in the heart to prevent excessive cerebral anaemia or cardiac failure. 
This is best done by auto-transfusion ; that is, by bandaging the ex- 
tremities from below upward in order to secure as large a quantity of 
blood as possible within the vessels of the trunk and brain. Actual 
transfusion of a T 6 ¥ of 1 per cent, solution of common salt into the 
bloodvessels is required when there is profound exhaustion and de- 
pression after haemorrhage. It has been demonstrated that it is not 
necessary to throw this solution directly into the bloodvessels, as inter- 
stitial injections seem to answer the purpose equally well. 

The milk secretion during the puerperal state presents abnormalities 
which call for treatment. " One may have to deal with anomalies of 
quantity or quality. The most frequent auomaly of quantity in milk 
secretion is unfortunately one of defect. Insufficient milk supply de- 
pends on a number of causes. Perhaps the most frequent is a lack of 
development of the glandular tissue, and in this form of insufficient 
milk secretion no treatment can be of avail. Where the lack of milk 
is clue to some intercurrent affection in the puerperal state the treat- 



584 DISEASES. 

ment must be directed toward this complication before the milk supply 
can be reestablished in normal quantity. It may be the consequence 
of hemorrhages or of diarrhoea or the result of an acute febrile attack 
during lactation or of inflammation within the gland itself. Serious 
organic disease may also be a cause, and insufficient nourishment must 
be held accountable in some cases. Profound emotions exert an ex- 
traordinary influence upon lactation in altering both the quantity and 
the quality of the milk. It has long been supposed that the return 
of menstruation has a disastrous influence upon milk secretion. This, 
however, has been definitely disproved by careful observations re- 
cently conducted in Austria. The return of normal menstruation 
without complications has no apparent influence, as a rule, upon the 
quantity or quality of the woman's milk. In all the temporary dis- 
eases interfering with milk secretion described above, it should be 
borne in mind that on the disappearance of the abnormal general or 
local condition, milk secretion can be successfully reestablished, even 
though it be absent for days or weeks. Electricity has been much 
vaunted of late as a remedy for insufficient lactation. It may be 
applicable in cases of torpidity of the mammary gland, or in those 
cases where lactation has been suppressed on the birth of a first child, 
and where the mammary gland, therefore, does not respond readily to 
the stimulus of subsequent births. This remedy will, however, often 
prove ineffective and disappointing. 

Instances of excessive milk secretion are not infrequently met with. 
In the milder and simpler forms they can be managed by regulation 
of the diet and free purgation. Galactorrhea, a constant flow of 
milk from the breasts, is one of the most stubborn forms of excessive 
milk secretion. Two measures can usually be relied on to give relief: 
firm compression of the mammary gland with the application of bella- 
donna ointment, or the administration internally of iodide of potas- 
sium. In some cases of this character milk secretion stops sponta- 
neously with the return of menstruation, and in a certain proportion of 
cases a treatment to secure a discharge of blood from the uterus has 
been successful in stopping the flow of milk. Success has been obtained 
with Simpson's plan of introducing a piece of caustic within the uterus 
in order to bring back the menstrual flow. Warm douches have been 
used successfully for this purpose. Electricity has been recommended 
to secure the proper contraction of the sphincter muscles of the lac- 
tiferous ducts, but as this is usually a result and not a cause of the 
galactorrhcea, the use of electricity must prove in the vast majority of 
cases ineffective. The long-continued administration of ergot has been 
warmly recommended. The remedy should be tried, for its use seems 
rational. Chloral has been shown to be very effective in diminishing 
the quantity of milk. This drug, therefore, is worthy of trial. It has 
recently been declared that antipyrine in 2J-grain doses, three times a 
day, will diminish milk secretion. The drug, however, has not been 
tested often enough to demonstrate its power. Quantitative anomalies 
in the milk secretion must often depend upon an ill-regulated diet. A 
fatty diet will diminish the quantity of milk ; a vegetable diet will 



PUERPERAL DISEASES. 585 

diminish the caseine, and fat will increase the sugar ; a diet rich in 
meat, especially if reinforced with alcoholic stimulants, will increase 
the fat and caseine, but will diminish the sugar. If the mother's 
milk is evidently disagreeing with the nursing infant, a chemical 
analysis of it should be made, and on the result rules regulating the 
diet should be adopted. The most common mistake in practice is to 
over- feed a nursing woman, especially with a milk diet, with the idea 
which prevails extensively among the laity that the cow's milk poured 
into the stomach appears again in the mammary gland. It is usually 
sufficient for a nursing' woman to observe the ordinary diet which 
agrees with her under all circumstances, with the addition perhaps of 
a half-pint of milk midway between the morning and mid-day and 
mid-day and evening meals. Occasionally a wineglassful of malt at 
the mid-day and evening meals is a useful addition to the diet, and in 
anaemic patients the addition to the malt of 5 grains of pyrophos- 
phate of iron will be an advantage. 

There is found in every pregnant woman some alteration in the 
constitution of the blood, which consists, roughly speaking, of a dimi- 
nution of the red blood-corpuscles, and of the albumin and the iron 
in the blood, with an increase in the white blood-corpuscles and the 
watery element. In some cases this change is much exaggerated, 
until an intense degree of anaemia appears in the puerperal state which, 
in its severity, will simulate pernicious anaemia, or some fatal form of 
blood-disease. The ana3mia of puerperal women, however, even in 
exaggerated cases, usually yields to treatment in a most gratifying 
manner. After the prolonged use of Blaud's pills, the writer has seen 
the blood-corpuscles rise from less than three to nearly four and a 
half millions, and the haemoglobin increase from 40 to 75 per cent., in 
a few weeks. In some cases arsenic alone succeeds where iron fails 
completely. 

Eclampsia. 

To treat eclampsia intelligently and successfully it is necessary to 
understand its etiology as fully as modern knowledge permits. Al- 
though the subject needs more light from future investigations, enough 
is now known to justify the following statement : 

1. The cell activity of mother and foetus produces excrementitious 
substances which will surely prove virulently poisonous to the whole 
organism unless they are voided or made harmless by the excretory 
organs. 1 

2. These organs in the childbearing woman are often inadequate to 
the disposal of effete material from the maternal and foetal bodies. 

3 Consequently, poisons, of a nature not yet demonstrated, are 
stored up in the maternal blood until, by cumulative action, their 
presence is manifested in the eclamptic seizure and other symptoms. 

4. The convulsions are probably the result of an acute cerebral 
anaemia brought about by violent contraction of the arterioles ; pos- 

1 Harold C. Ernst: American System of Obstetrics, vol. ii. p. 431. 



586 DISEASES. 

sibly by direct irritation of the brain substance. As a result of in- 
tense muscular action the circulation is interfered with and blood is 
determined to non-muscular regions, as the brain, lungs, kidneys, 
etc., to such a degree that the congestion of these parts become dan- 
gerous, leading to apoplexy in the brain, oedema in the lungs, and 
often a complete abrogation of renal function. 

The indications for treatment in convulsive seizures of this nature 
are plain : 

First, to attack the fons et origo mail, and to eliminate the poisons 
from the blood as quickly and in as large quantities as possible. 
Second, to diminish nervous sensibility and lessen muscular power, 
in order to reduce the convulsions in vehemence, duration, and fre- 
quency. Third, if convulsions occur during labor, to save the infant 
without adding to the risk of the mother. Fourth, to guard the 
woman from injury during the attack. 

The first indication is met by venesection, diaphoresis and cathar- 
sis. By the first, one eliminates a certain quantity of poison along 
with the blood and relaxes the muscles. If there is sharp post- 
partum haemorrhage, or if the patient is from auy cause weak and 
ansemic, bloodletting is not called for. In the ordinary case, how- 
ever, with full pulse, congested head, the veins standing out upon the 
neck and face, venesection is an undoubted advantage. While the 
median basilic of one or both arms is being opened, some croton oil 
should be sent for and 2 drops mixed with sweet oil may be placed 
upon the tongue. Directions should at the same time be given to 
wring out three or, better, four old blankets in boiling water ; these 
are to be wrapped around the legs, trunk and arms, and well covered 
over with one or more dry blankets. The sweating thus induced is 
profuse. An ice-bag must be put to the head to prevent over-con- 
gestion of the brain. In this way one eliminates the cause of eclamptic 
convulsions as quickly and thoroughly as possible from the blood, 
directly and indirectly through the skin and bowels. The latter may 
be acted upon by \ grain elaterium rubbed up in butter, or by com- 
pound jalap powder and calomel, instead of resorting to the croton oil. 
Pilocarpine seemed at one time an ideal remedy to secure diaphoresis 
in eclamptic cases, but it has lately fallen into well-deserved disrepute. 
It much increases the danger of pulmonary oedema and is too pro- 
found a depressant. It is no longer employed by experienced and 
educated obstetricians. The second indication is best met by an 
anaesthetic. Usually the convulsion first shows its approach in the 
eyes ; these should be closely watched, so that on the first symptom 
of the oncoming attack chloroform may be at once administered and 
pushed as rapidly as possible. Ether is inadmissible in these cases, 
for it is slow of action, congests the brain, and irritates the kidneys. 
Just before the woman is wrapped in blankets, 1 drachm each of 
chloral and bromide of potassium in starch-water should be injected 
into the rectum. This may be repeated in an hour if necessary. 
Morphine, veratrum viride, and inhalations of nitrite of amyl, have 



REMITTENT FEVER. 587 

their enthusiastic advocates in this connection. They may be held in 
reserve, in case the plan of treatment described needs reinforcement. 

If convulsions come on during labor, the child should be rapidly 
extracted as soon as the os is well dilated, but not before, because 
efforts to dilate the os would be very apt to increase the convulsions, 
and would attract the physician's attention from the woman's most 
threatening danger. Moreover the os dilates naturally with unusual 
rapidity during eclampsia. 

The only injury to be feared during eclamptic attacks is wounds 
of the tongue from the teeth. This can be prevented by inserting be- 
tween the teeth a brush-handle wrapped in a handkerchief, or by 
drawing a towel into the mouth like a bit. Well-meaning but igno- 
rant bystanders will sometimes throw themselves upon an eclamptic 
patient to restrain her convulsions by force. This should be forbidden. 



REMITTENT FEVER. 

This is sometimes called bilious fever, by reason of the violent 
bilious vomiting and jaundice which often accompany it. It separates 
itself from intermittent fever by the fact that the patient's condition, 
chiefly as regards temperature, does not have normal intervals, but 
has periods of only temporary improvement, or, in other words, the 
disease remits. 

For the proper treatment of this fever, three things must be borne 
in mind: 1. It is more dangerous than intermittent fever. 2. It is 
dangerous in the hot stage, not in the cold stage. 3. The patient, 
not having periods for complete or partial recovery, rapidly loses 
strength. The safety of the patient depends upon the use of large 
doses of quinine to cut short the pyrexial stage, the doses used being 
from 20 to 30 grains, preceded by a good-sized purgative dose of calo- 
mel, say 3 to 4 grains. If vomiting is too violent to permit of the 
retention of the quinine, it must be used by the rectum and hypoder- 
mically, and the stomach and intestines be swept out by the use of 
divided doses of Seidlitz powder of citrate or sulphate of magnesium. If 
purgatives are used, they should precede the quinine by twenty min- 
utes, as otherwise the latter drug is swept out into the bowels, where 
it is rendered useless by reason of its precipitation by the alkaline 
juices there present. Many clinicians claim that remittent fever is 
chiefly benefited by quinine during the remission, and ciuchonism dur- 
ing the pyrexial stage increases the discomfort of the patient undoubt- 
edly. If pyrexia is excessive, relief must be sought in the cold pack 
and antipyrine. 

The best treatment of the vomiting is the use of small doses of mor- 
phine, or 3 to 5-drop doses of the spirit of chloroform in from 30 drops 
to 1 drachm of cherry-laurel water. Aconite may also be used if the 
patient is strong enough. (See Vomiting.) 

If the belly is tender, a turpentine stupe should, be applied. (See 
Turpentine.) 



588 DISEASES. 

If intestinal haemorrhages occur, gallic and tannic acids or Monsel's 
salt, in the dose of 3 grains in hard pills may be used, and cold cloths 
he placed over the belly. (See Haemorrhage.) 

If haematuria appears quinine must be avoided unless the necessity 
for its employment is absolute, because the paroxysms recur frequently. 
Quinine does the haematuria harm. (See Collective Investigation by 
author in Therapeutic Gazette, July, 1892.) 

The treatment of convalescence consists in the use of tonics, such as 
quassia, calumba, gentian, Huxham's tincture, arsenic, and purgatives 
when needed, with attention to the kidneys, the potassium salts being 
chiefly employed to keep them active. (See Intermittent Fever.) 



RETINITIS. 

Retinitis, or inflammation of the retina, often associated with chor- 
oiditis, is commonly the result of several constitutional diseases : 
Bright's disease, diabetes, syphilis, etc. In some cases no cause can 
be found. The general remedies must be directed according to the 
supposed cause, and the eyes must be protected from light and all 
close work avoided. Very distinct retinal irritation may be caused by 
eye-strain, which is to be relieved by the prolonged use of atropine 
and dark glasses, and later suitable lenses for the correction of any 
existing error in refraction. 



RHEUMATISM, ACUTE ARTICULAR. * 

No better example of the fact that therapeutics is in advance of 
pathology can be adduced than the disease known as rheumatism. 
The therapeutist cannot tell how he cures the condition designated by 
this name, simply because the pathologist cannot tell what the cause of 
the disease is, and when this information is forthcoming from the one 
side an explanation will be immediately given by the other. This 
being the case, we must devote ourselves to the study of pure empiri- 
cism, and not to logical pharmacology. 

The treatment of acute articular rheumatism is divided into that 
portion devoted to the cure of the disease process, and that directed to 
the relief of the pain and of the local manifestations of the disease. 

When an acute attack of rheumatism comes on, it is nearly always 
accompanied by a high temperature, a bounding pulse, and all the 
evidences of active systemic disturbance accompanying inflammatory 
outbreaks, which, in this particular instance, involve the joints. We 
may, therefore, use at such times the remedies which we have learned 
are best able to combat inflammation, namely aconite and veratrum 
viride. So powerful are these drugs in the early stages of acute rheu- 
matism that some persons have believed them to be possessed of a 
specific anti-rheumatic power. This is, however, highly unlikely, as 



RHEUMATISM, ACUTE ARTICULAR. 589 

they act no better here than in other inflammatory conditions else- 
where. 

The proper manner in which to use the tincture of aconite under 
these circumstances, in a strong healthy individual, is to administer 
3 drops at once in a little water and follow it by a teaspoonful of a 
mixture containing 5 drops of tincture of aconite and 2 ounces of 
water, every half-hour until perspiration on the skin betokens circu- 
latory depression through the action of the drug. If this is not done 
veratrum viride in the same proportions may be used. The advan- 
tages of this treatment are numerous : first, it allays the fever ; second, 
it quiets nervous excitability ; third, it tends to prevent permanent 
changes in the joints which are involved ; and, last of all, it aids in 
the production of a sweat. Whenever these drugs are employed the 
patient must be strong and hearty, not debilitated or weak, and it is 
to be noted that this treatment is not to be resorted to carelessly. 
Finally, care is to be taken that the symptoms of depression from the 
drug and the disease combined do not become too severe. Where 
great exhaustion is primarily present, or ensues upon the use of depres- 
sant drugs, alcoholic stimulants are particularly needed. 

Simultaneously with these internal measures a solution of bicar- 
bonate of sodium, 20 grains to the ounce, may be applied to the joints 
involved by means of lint wet with this solution, with relief to the 
sense of heat and burning, or ice-cold compresses may be tried. In 
other cases relief may be obtained by applying hot cloths saturated 
with the so-called Fuller's lotion, namely, carbonate of sodium 6 
drachms, laudanum 10 ounces, glycerin 2 ounces, and water 9 
ounces. Sometimes great relief is obtained by fixation of the joints 
by means of splints. 

Immediately after the* system has been thoroughly impressed by 
cardiac sedatives — or at once, and in their place, if the case is not 
seen at first, or is weak — the physician should resort to one of three 
remedies, namely, salicylic acid or its salts, antipyrine, or acetauilide. 
The general opinion of the profession seems to be that these three 
remedies stand in the order here placed in regard to their efficiency, 
but it is also true that one will often succeed when the other fails, 
and it is worthy of note that success or failure generally asserts itself 
rapidly — that is, the drug used gives relief in twenty- four or seventy- 
two hours, or fails altogether. It is most important to remember 
that salicylic acid seems to protect the cardiac valves and the entire 
endocardium from the ravages of the disease more than do the other 
two remedies, and in addition that this acid, by reason of the profuse 
sweats often produced by it and a tendency to produce cardiac depres- 
sion, must be watched lest it act unfavorably on the general systemic 
state. 

Taking up salicylic acid first, we find that its proper use is often 
misunderstood, and that it fails because of this fact. Whenever acute 
articular rheumatism appears, the salicylic acid should be pushed in 
the same way that we use quinine on the advent of a malarial par- 
oxysm, namely, in full dose. 



590 DISEASES. 

It is useless to give the drug in 5 or 10 grain doses three times a 
day ; it must be given in 20-grain doses morning, noon, and night, or 
not at all. If the sweats are too severe, or the stomach rebels, the 
drug may be stopped, but not decreased in amount, unless for good 
reason. Further than this, if salicylic acid is used for two or three 
days in this way, and produces evidences of cinchonism, yet fails to 
alter materially the course or severity of the trouble, it should be 
withdrawn, as it will rarely, if ever, do any good after this time. 

A very efficient substitute for salicylic acid is the oil of gaultheria 
(wintergreen), which contains about 90 per cent, of salicylate of 
methyl. The dose should be 10 to 20 drops on a teaspoonful of sugar, 
or in capsule or emulsion, three times a day, after meals. 

Antipyrine and acetanilide may both be considered together, since 
their action is identical in rheumatism. The author believes that 
antipyrine, while often relieving the pain more than the acetanilide, 
nevertheless does not act so favorably in decreasing the duration of 
the disease. The dose of the first should be 10 to 20 grains three 
times a day ; of the second, 4 to 8 grains at the same intervals. 

The studies of Guttmann with acetanilide in a very large number 
of cases of rheumatism, embracing all its forms, both chronic and 
acute, have given most encouraging results, and the author has seen 
the drug act most happily in several cases which had refused to yield 
to the iodides and salicylates, although all of these cases were of the 
severe acute form, suffering intense pain from the articular inflamma- 
tion, but devoid of any cardiac complications. It at once becomes 
evident that a drug such as antipyrine or acetanilide may do good in 
a case of rheumatism in three entirely separate and distinct ways, any 
one of which may be active at once, or all active together, hand-in- 
hand in the improvement of the patient's state. Any substance pos- 
sessing strong antipyretic power must be of value under such circum- 
stances, because of the lowering of the fever which follows its admin- 
istration, with the resulting quieting of an excited system, and in 
putting aside the delirium associated with a condition of hyperpy- 
rexia. ~Not only does such a drug act favorably in this manner, but 
the analgesic effects of such a substance must exert a powerful influ- 
ence for good. By benumbing the sensibility of the patient to the 
excruciating pain consequent upon movement, and so putting aside 
the nervous wear and tear of sleeplessness and suffering, the patient's 
state must be improved, or, at least not grow worse from the exhaus- 
tion of the long hours of agony. Further than this, it would seem 
probable that acetanilide possesses a direct anti-rheumatic influence, 
allaying the disease processes even in those forms where, pain being 
largely absent, the improvement must be real and not apparent. 

The intention of the author is not to extol the value of acetanilide 
and antipyrine in rheumatism to the exclusion of other means of 
relief, nor to recommend its use before the more thoroughly tried sal- 
icylates and iodides, but to draw to its standard a certain number of 
cases which persistently resist treatment of the ordinary stamp and 
which put the physician to his wit's end for a change of treatment at 



RHEUMATISM, ACUTE ARTICULAR. 591 

least promising some chance of relief. Many of the readers of this 
book have doubtless seen such cases, and many of them must have 
learned by sad experience that acute articular rheumatism is in many 
cases bound to run a course of so many weeks or days, do what we 
will. Under these circumstances nothing acts further than a pal- 
liative, and the patient and his friends become impatient for a chauge. 
The author has found that acetanilide in such cases will often relieve 
the pain and so permit a refreshing sleep, in doses of from 4 to 8 
grains three times a day, and that these amounts do not cause the ex- 
cessive sweating which the necessarily large doses of salicylate are sure 
to produce, sweats which leave the patient oftentimes almost dyspnceic 
from very weakness. Whether this temporary relief produces such 
changes in the system as to permit of a better battle against the dis- 
ease, or whether it actually counteracts the rheumatic poison, we know 
not ; but we do know that following its employment the relief is not 
only temporary but often permanent, and that a very distinct step in 
advance is made toward the close of the attack if any influence at all 
is felt, 

Phenacetine is often very useful when used in rheumatism, particu- 
larly if combined with salol. 

Passing from what may be appropriately called the coal-tar treat- 
ment of rheumatism, because all the drugs so far named for internal 
use have such a source, we come to a list of remedies heretofore 
largely used in rheumatism in place of the newer compounds, but 
which are not so commonly employed to-day. 

These remedies act, as a rule, in the subacute forms of rheumatism 
or in the cases where the first group fail because the disease is obstinate. 
Of these the chief is the iodide of potassium followed by the acetate, 
bicarbonate and citrate of potassium. If the iodide is used the fol- 
lowing prescription is of service : 

Be. — Potassii iodidi ^j. 

Syr. sarsaparillse comp. . . . . f^vj. M. 

S. — Dessertspoonful three times a day, after meals. 

In other cases it is best, because of the disagreeable taste of the 
iodide, to give it in sugar- coated pill or in tablet form, but care should 
be taken that milk or water is taken at the same time to prevent 
gastric irritation. 

Or, if preferred, 20 to 30 grains of the bicarbonate of potassium 
may be taken every four or five hours in water, flavored with cinna- 
mon for the sake of the taste, or the citrate of potassium, which is 
more agreeable, may be taken in equal amount. Sometimes a little 
colchicum added to the prescription given above may be useful if the 
case is very obstinate, as follows : 

R. — Potassii iodidi ._ . . . gj vel Jij. 
Yini colchici radicis . . . f % y vel f % S& 
Syr. sarsaparillse comp. q. s. ad f § vj vel f §xij. M. 

S. — Dessertspoonful three times a day, after meals. 



592 DISEASES. 

Haig has proved that in rheumatism there is retention of uric acid, 
and that the use of alkalies and the salicylates at once causes this 
substance to be changed into a soluble form ready for elimination. 

The other drugs used in acute rheumatism are numerous, but ouly 
a few of them deserve attention here. There is abundant evidence on 
record that full doses, 10 to 30 drops, of the fluid extract of cimicifuga 
if given every five hours will decrease the redness and pain of the 
joints and shorten the attack in some cases. Again, certain species of 
rhus, as rhux toxicodendron, are useful if fresh preparations are at 
hand. The dose of rhus toxicodendron is -^ to 1 drop of a tincture 
made by adding one part of the fresh leaves of poison-ivy to 2 parts 
of alcohol, this dose being taken three times a day. Where the pain 
seems particularly severe at night this drug is very valuable, according 
to many careful students of therapeutics. 

Nearly every case of acute rheumatism will do better if a strong 
mixture of lemon- or lime-juice and water be taken daily in large 
quantities. 

The local remedies in rheumatism are chiefly counter-irritants and 
sedatives. Thus, small or large blisters applied around an inflamed 
joint after the general systemic excitement is passed, may be of great 
value in restoring the suppleness of the joint and in aiding in the 
absorption of the eifusion. The remaining local treatment consists in 
thoroughly painting the inflamed parts with tincture of iodine, if blis- 
ters are not used, and in the application of veratrine ointment or 
iodine ointment around the joint. (See Veratrina.) 

A most valuable application to the inflamed joints of rheumatism, 
either during the acute stage or afterward when they remain swollen 
and enlarged, is : 

R. — Ichthyol ^iv vel ,^j. 

Adipis ^ij. M. 

S. — Apply about the part and rub in well. 

High fever is to be controlled by the same measures as the high 
fever of any other disease, by antipyretics, by the cold pack, cold bath, 
or sponging with tepid or cold water. 

Salol, which is dissolved and absorbed solely in the intestine through 
the action of the juices there present, has been used in the place of 
salicylic acid with success ; but it is worthy of note that, as it contains 
40 per cent, of carbolic acid in addition to the salicylic acid, its use in 
very large amounts is dangerous. (See Salol, page 297.) 



RHEUMATISM, CHRONIC. 

Chronic rheumatism is one of the most difficult and obstinate dis- 
eases with which we have to deal. In some cases the acute form just 
considered merges slowly into the chronic form ; or, in other instances, 
the disease gradually comes on, increasing, it may be, by exacerba- 
tions or by gradual progression. The treatment of chronic rheuraa- 



RHEUMATISM, CHRONIC. 593 

tisrn is somewhat different from that of the more acute forms, and 
approaches that of goat in some of its therapeutical indications. In 
other words, the salicylates are not so useful in these cases as are the 
iodides and colchicum, so that, in the majority of instances, the pre- 
scription of iodide, sarsaparilla, and colchicum, given in the article on 
Acute Rheumatism indicated. When anaemia or weakness is present, 
cod-liver oil is often of great service, and it is, worthy of note that 
this useful nutritive remedy was first brought into therapeutics by 
the fishwives of Holland, who found it useful in the attacks of rheu- 
matism to which their husbands were subjected through exposure. 

When the oil is thoroughly rubbed into chronically inflamed joints 
it is ofteu as useful as when taken internally. 

The same forms of severe counter-irritation are not so useful in 
chronic rheumatism as in acute rheumatism, but a very valuable 
therapeutic measure in these cases is the use of the Russian or Turk- 
ish bath or an improvised sweat by means of a lamp and a blanket. 
(See Heat, page 360, and Cold, page 344.) Liniments are always 
called for, for two reasons : First, they relieve pain and do good to 
the parts, if not from their medicinal properties, at least by the rub- 
bing which accompanies their application ; second, because they give 
the patient something to do, or to have done, and therefore impress 
him with the object-lesson that his attendants are attendant and alive 
to his suffering and need of sympathy and care. 

Among the lower classes the belief in liniments is very widespread, 
and their use will often instil into the minds of the friends a far greater 
confidence than the most logical of treatments with the liniment left 
out of the list of remedial measures. 

The following liniments will be found very useful under these 
circumstances : 



S. — Poison 

Or, 

R.- 



-Tr. aconiti .... 
Tr.opii . . 

Olei terebinthinse 
Linimenti saponis 
. Use as a liniment three times 


• ' ' f f # 

fgjvelf^ij. 
q. s. ad f^ viij. 
a day. 


-Aquae ammonii fort. 
Olei cajuputi 
Tr. belladonnas 
Linimenti camphorse . 


. f^iv. 

. fljvelf.fij. 

q. s. ad f ^ viij 



M. 



M. 



S. — Poison. Use as a liniment. 

Or, 

K.— Tr.opii ] 

Tr. aconit. > . . . . aa f^iv. 

Aquae ammon. fort. J 

Linimenti chloroformi . . . . f^vj. M. 

S. — Poison. Use as a liniment to chronically inflamed muscles or joints. 

In other instances the greatest relief is obtained by employing the 
following ointment of veratrine : 



594 DISEASES. 

K • — Veratrinse \ _ . 

Hydrargyri iodidi viridi J ' * ' c 6J- 

Petrolati gj. M. 

S. — Use as an ointment over the joints. 

This ointment ought not to be widely distributed, and the pulse and 
respiration should be watched, as the veratrine may be absorbed and 
depression of a severe character set in. 

For the reduction of enlargements of the joints due to the disease, 
and accompanied in some cases by pain, the following ointments are 
serviceable : 

R. — Unguent, iodinii 5j. 

Adipis givvel %]. M. 

S. — Apply locally. 

Or, still better : 

Be. — Ichthyol. ^ivto 5jj. 

Adipis Jj. M. 

S. — Kub into the joints thoroughly. 

Ichthyol is certainly the most efficient remedy that we have for the 
enlarged and painful joints. 

The employment of red flannel over inflamed joints is no better 
than the use of white flannel, and it is never beneficially ct medicated," 
as claimed in the stores. The only advantage of red flannel is that, as 
it is dyed, the wool is often better for not being thoroughly bleached, 
and is in larger amount for this reason. The disadvantages of red 
flannel are that it stains the clothes and the possibility of its producing 
irritation of the skin, or even systemic effects of an evil character. 



RICKETS. 

Rickets may be defined as a state of the body of an infant or child 
in which there is a deficiency of the normal salts of the bones and 
tissues, with corresponding enlargement of the animal portion of the 
bone, or, in other words, the cartilaginous parts. Generally the term 
is applied solely to designate bony troubles, but every practising phy- 
sician sees cases where the manifestations of rickets are emphasized in 
gastro-intestinal disorders rather than in bony deformities. The chief 
cause of rickets in children, aside from the presence of any disease 
such as scrofulosis, is inanition, that is, non-nutrition of a specialized 
form, or, in other words, bone-salts starvation. This may occur after 
or before birth, and it is quite common to see children, born of 
mothers ill-fed or whose assimilation of salts is defective, with soft 
bones or a distinct tendency to rickety development. 

The treatment of rickets is, therefore, largely dietetic and devoted 
to the improvement of the food and digestion. No part of the body 
fails in force more than the digestive apparatus in the presence of this 
disease, probably because the alkalinity of the blood is altered, and 



RICKETS. 595 

partly because the stomach cannot secrete properly formed juices from 
imperfectly nourished glauds. 

The medicines to be used in rickets are general tonics, digestive 
tonics and stimulants, and bone tonics and stimulants, such as salts of 
lime and phosphorus. The general tonics are quinine, cod-liver oil, 
nux vomica and iron, while the digestive tonics are the simple bitters, 
physostigma and mineral acids. The bone tonics and stimulants are 
lime salts, phosphorus and phosphate of zinc. 

Tonic treatment is best carried out in young children by the ad- 
ministration of quinine in the form of quinine chocolates or by the 
use of strychnine in the dose of yj-g- to t ^q- of a grain in sugar-coated, 
pink granules. Arsenite of copper in the dose of -j-g-g- of a grain in 
tablet triturate three times a day is also useful. 

A very useful preparation is the following : 

1& . — Olei morrhuse f ^ vj. 

Syr. calcis lactophosphat \ aa fliii M 

Liquor, calcis J o J- 

S. — One-half to one teaspoonful two or three times a day. Shake thoroughly. 

Nux vomica is generally so bitter as to be rarely administered to 
young children, and when given, only J to J of a drop of the tincture 
should be used, three times a day. 

Where a distinct scrofulous tendency exists and ansemia is present 
small doses of the syrup of the iodide of iron are of service, and T 1 ^ 
to 1 drop may be given three or four times a day to a child of six 
months or a year, thus : 

R . — Syrupi ferri iodidi . . . gtt. iij vel xxiv. 

Aquae dest. . . . . . q. s. ad f^iij. M. 

S. — Teaspoonful every four or five hours during the day. 

Or, 

Be . — Syrupi ferri iodidi . . . gtt. v vel xx. 

Syrupi q. s. ad f^iij. M. 

S. — Teaspoonful three times a day, after meals. 

Here again the arsenite of copper becomes particularly valuable. 

The salts of lime and sodium are of direct benefit to the bones, 
forming by their presence in health a large proportion of the osseous 
system, and, therefore, they may be considered as foods rather than 
drugs. Very often their administration to nursing mothers or preg- 
nant women saves the maternal teeth from caries and preserves the 
general health of the mother and child. The following prescription 
may be used : 

R. — Syrupi calcis lactophosphatis . . . f^iv. 
S — Half to one teaspoonful three times a day, after meals. 

The reasons for the use of phosphorus are clear, from what has been 
said of that drug when speaking of it elsewhere in this book, as it acts 
as a direct and powerful stimulant of bone growth. 

Phosphorus is best given to children in the form of very small, 
sugar-coated pills (^h) g r sucn as are P ut U P m tne ^ orm known 
as " pink granules " by manufacturing chemists. 



596 DISEASES. 

Phosphate of lime and phosphate of sodium are valuable remedies 
in rhachitis. They are never to be used in large doses, because they 
will not be assimilated, and will only disorder the stomach. The 
proper dose of each is 1 to 2 grains, placed in the milk, where their 
presence will not be noted. 

The ventilation of the rooms where a child prone to rickets is 
kept should be excellent, not too hot or cold, and free from draughts. 
A cool sponge-bath is useful at night if the patient is strong enough, 
or a good rubbing with salt and whiskey, 1 drachm of salt to a pint 
of whiskey, is of still greater service. 

Special attention should be paid to the development of the muscles 
by massage and passive movements, as these parts are always weak. 
"Walking must not be allowed too early, as it may cause bony de- 
formities. 

SCARLET FEVER. 

This disease, the most frequently fatal of all the exanthematous 
diseases of childhood, requires the greatest care in its treatment. 
Complications constantly arise, requiring skill on the part of the 
attendant, and it is upon his success in treating these outbreaks, as 
well as in the general direction of the case, that the life of the patient 
chiefly depends. It has been claimed by certain practitioners that 
one or two remedies which they have used act as abortifacients of 
the attack, decreasing its severity, duration, and the probability of 
complications. Thus, one European physician has used salicylic acid 
with wonderful results, if his claims are true, for he found it to pre- 
vent all complications, and even to remove them when present. He 
gives, throughout the entire attack, and for some days after defer- 
vescence has ensued, the following : 

Be. — Acid, salicylic gr. xlviij. 

Aquse destillat. . . . . . . f %ij. 

Syr. aurantii . . . . q. s. ad f^iij. M. 

S. — Teaspoonful every hour during the day and every two or three hours at 
night. 

In this country Wilson has employed chloral throughout the entire 
attack with asserted good results, in the following manner, but in 
our opinion Wilson's method is not the best for most cases, unless 
the nervous manifestations are very marked, when the chloral treat- 
ment is of great value. 

The plan is as follows : "As soon as the patient is suspected or 
known to be developing scarlatina, a laxative dose of calomel, pro- 
portionate to the age and general condition, is administered. Shortly 
thereafter chloral is given in moderate doses, at intervals of two or 
three hours, or longer, throughout the attack. The dose varies with 
the age of the child ; the frequency of its admiuistration depends 
largely upon its effect. To infants of two or three years a dose of 
from 1 to 2 grains may be given, the dosage being gradually in- 
creased with older children ; that for adolescents reaching 5 grains. 



SCARLET FEVER. 597 

The tranquillizing and sleep-producing effects of the drug are, in 
most instances, promptly realized, the patient falling into a condition 
of quietude instead of the restlessness and jactitation which are so 
distressing in the well-developed disease. 

" The repetition of the dose should not be more frequent than is 
necessary to maintain this condition of quietude, a condition from 
which the patient may be easily aroused, and into which he quickly 
relapses when left undisturbed. It is neither necessary nor desirable 
to push the drug to the establishment of a deeper sleep. Profound 
narcotism is, of course, to be avoided. The patient may thus be 
kept in a coudition of light repose throughout the whole duration of 
the fever. By this means not only is there obtained relief from the 
restlessness and distress of the active period of disease, but much 
wear and tear of the nervous system, and some exhaustion from 
muscular effort, are prevented. Delirium is controlled ; the itching 
and burning of the skin, due to the eruption, are allayed ; in a word, 
the greater number of the distressing symptoms of the disease are 
favorably influenced by the cautious and prolonged administration of 
chloral hydrate in efficient doses.'' 

As a rule, the drug is easy of administration, and well borne by 
the stomach. Wilson has found its acrid after-taste best masked by 
its administration in Aubergier's syrup of lactucarium, diluted, thus : 



K . — Chloralis gr. xxx. 

Sjriip.lactncarii(Aubergier)| „ f ^ ss>velf gj. M . 

S. — A teaspoonful in iced water every two, three, or four hours. 

" The administration of nourishment immediately after the medi- 
cine is desirable. The sleep-inducing properties of the drug manifest 
themselves rapidly, but are not prolonged ; therefore, its repetition 
at intervals of two or three hours is called for." 

From the very beginning of an attack to its end, unless diabetes 
comes on, the child should be supplied with plenty of pure water, 
and, if possible, this water should be obtained from a spring con- 
taining a low percentage of solids, as Poland water, which is widely 
sold throughout this country. If this is impossible, then Vichy water 
may be employed, or it may be used by obtaining the granulated 
Vichy salts sold by most large drug firms, and adding this in small 
amounts to pure filtered water. This makes an effervescing draught 
which may be taken while bubbling or not, as the child desires. The 
object of this treatment is to flush out the kidneys, and so to dilute the 
effete matters, generated in the body by the fever and the germs of the 
disease, that they lose, to a great extent at least, their poisonous and 
irritating powers. 

In other cases a prescription containing sweet spirit of nitre and 
citrate of potassium proves useful, as follows : 

R •— Spt. aether, nitros f,l.j : 

Potassii citratis .^ij* 

Aquse q. s. ad f Jvj. M. 

S. — Teaspoonful every two hours if urine is high-colored. 



598 DISEASES. 

The convulsions which sometimes usher in an attack are to be 
treated by 5-grain doses of chloral and 10 to 20 grains of bromide of 
sodium for a child of five to eight years. The convulsions of the 
advanced stages are often ursemic, and must be treated appropriately. 

The further treatment of the disease rests upon the symptoms 
alone. We cannot cure the patient by the use of remedies, but we 
can do much toward making the pathway to health smooth and free 
from pitfalls and obstructions. 

Probably the most common complications calling for treatment, 
when the kidneys have been treated in the way just spoken of, are 
high temperature, or fever, and sore-throat or angina. The fever is 
to be controlled in these cases in precisely the same way that it is in 
all other conditions in which it is present. It is best to attempt to 
keep it down below 101°, or at least below 102°, by tepid sponging, 
which also allays the itching of the skin ; or, if the fever still rises, 
by the use of colder water, or even the cold pack, if the parents will 
allow it. Generally the popular fear that the application of cold to 
the surface will drive the eruption "inward" is so strong as to make 
the cold pack objectionable in the eyes of the friends ; but, if the 
temperature reaches 105°, the physician must assert the fallacy of 
this belief, and insist on its use. (See Cold Pack, page 352.) If 
suppression of the rash does occur, we must use the wet pack. Anti- 
pyrine and acetanilide, to be sure, may both be used; but it is worthy 
of note that each of these may produce collapse, or other complica- 
tion, if large doses are necessitated by obstinate high temperature. 
If these complications ensue, alcohol will be indicated. Quinine has 
been highly recommended as an antipyretic in scarlet fever, but it is 
of little value in the majority of cases, simply disordering the stomach 
and irritating the kidneys, if used in doses large enough to be effective. 
Where the head seems to be particularly hot and the fever is high, 
an ice-bag or a head-coil of rubber tubing is to be employed, and 
through the latter water may be circulated at whatever temperature is 
thought best. (See Cold, page 347.) 

The treatment of the sore-throat of scarlet fever is an important 
part of the care of the child in many cases. Small pellets of ice may 
be held in the mouth, and au ice-bag applied to the outside of the 
throat. This is done by finely breaking up some ice and placing it 
in a thin India-rubber bag about the neck, the surface of the bag 
being covered by a cloth, to prevent too rapid melting of the ice and 
the wetting of the clothes by the condensation of moisture on the 
face of the bag. This treatment should be used during the entire 
attack, if needed, and the contents of the bag renewed as often as 
the water becomes at all warm from the heat of the body. By this 
means the redness of the fauces and the swelling of the glands of 
the neck are prevented or relieved. Chlorate of potassium may be 
used in a spray or on a swab, but never internally, owing to its irri- 
tant effects upon the kidneys and stomach and its general influence on 
the blood. 

In some cases where the eruption fades, or is never very prominent, 



SCIATICA. 599 

it is of the greatest importance that it be made active. Under these 
circumstances the child may be placed in the warm wet pack, and, if 
the head is very hot, cold applied to the vertex and throat, while the 
body is enveloped in the blanket. (See Heat.) This often brings out 
in an hour or two a bright scarlet rash, aud the child falls asleep and 
wakes up free from delirium and high fever. 

The itching and burning of the skin in many cases of scarlet fever 
are annoying symptoms, and they may become really dangerous. The 
author has recently carried out a series of experiments showing that 
fever of high degree can be brought on solely through nervous irri- 
tation, thus explaining a fact long well known to clinicians, namely, 
that the relief of this dermal irritation in scarlet fever may be followed 
by a fall of temperature. To relieve this symptom it will often be 
found advisable to cover the entire skin with a thin layer of vaseline 
or cosmoline, or benzoated lard, or, in other cases, as an antiseptic 
and local anaesthetic, carbolized oil may be applied (2 drops of car- 
bolic acid to each 2 ounces of olive oil). In other cases almond oil 
may be used. 

If nephritis comes on and is a pressing condition the greatest care 
is necessary, and the object of the physician must be to make the skin, 
disabled as it is, carry out a sufficiently active eliminative function to 
relieve the kidneys of any strain, to relieve dropsy, and to aid in the 
removal of effete matter by producing catharsis. These effects are 
best attained by the use of pilocarpine : ^ grain by the mouth, for a 
child of ten years, or -^ grain hypodermically. If cardiac weakness 
exists this drug cannot be given, and we are forced to the use of from 
5 to 10 grains of compound jalap powder to a child of ten or 
twelve years, to which should be added 10 grains of bitartrate of 
potassium to increase its efficiency. Sweating may also be produced 
by the employment of heat obtained by the use of bottles of hot water 
or hot bricks placed about the patient, who is first wrapped in 
blankets so that the bottles cannot burn the skin and so arranged 
that sweating will come on. The thermometer must be placed in the 
mouth to foretell any danger from heat-stroke if the sweat should fail 
to appear. In such cases the hot pack is of great value. (See Heat.) 

The after-treatment of scarlet fever, during convalescence, consists 
in the use of Basham's mixture or the tincture of the chloride of iron 
and in the employment of simple bitters, strychnine, or quinine. 
Fresh air, sea air, or mountain air are useful, whilecold or exposure 
to cold air or draughts is to be carefully guarded against. 



SCIATICA. 

Sciatica is an exceedingly obstinate affection, in the majority of 
cases resisting the best treatment for weeks. It seems to be due to 
rheumatic taint in the majority of instances, and may sometimes be 
cured by the remedies used and described under the heading of acute 
or chronic rheumatism. In other instances it is due to injury or 



600 DISEASES. 

jarring of the nerve, as by heavy persons stepping off from a high 
step to the hard ground. Thus the most obstinate case ever seen by 
the writer was one in which a stout man weighing about 250 pounds 
acted as " coupler " on a switching engine, and though wonderfully 
agile for his weight, provoked the disease in the leg on which he 
always first struck the ground when jumping from the platform of the 
moving locomotive. 

The treatment for all cases is both internal and external. The in- 
ternal treatment may be the same as that already described under 
acute or chronic rheumatism, or in other instances consists in the use 
of large doses of bitartrate or citrate of potassium, 40 grains three 
times a day in plenty of water to aid in the maintenance of free 
kidney action. At the same time the amount of coffee and tea should 
be cut down as much as possible, and lemonade, strongly acid, be 
taken freely during the day. If the pain is very excessive, morphine 
should be given, or antipyrine or acetanilide may be used. 

The local treatment of sciatica is quite various. One of the favorite 
methods is to inject deeply into the flesh, just over or about the exit 
of the nerve from the pelvis, 10 to 20 minims of chloroform, or, in- 
stead of the chloroform, J to \ grain of morphine in 30 minims of 
water which has first been distilled and sterilized, may be used 
with equally good results and less danger of sloughiug. Other 
physicians prefer acupuncture, the needle being driven down until 
the sheath of the nerve is punctured. Still another useful method is 
to take a strong glass rod with a round, smooth end, and after anointing 
the skin over the course of the nerve with a little ichthyol ointment 
or lard, to pass the end of the rod back aud forth over the tender area, 
using as much pressure as can be borne. By this means massage or 
pressure on the nerve is accomplished. In other cases the daily use of 
an ether or rhigolene spray over the part is effective, or kataphoresis 
may be resorted to. 

The liniments recommended in chronic rheumatism may be tried, 
and cod-liver oil is of service in obstinate cases. Sometimes nerve- 
stretching must be performed before a cure is effected. 

Gundrum has employed wet cupping over the course of the diseased 
nerve to the number of 5 to 10 cups with very extraordinary results. 



SOLERITIS. 

Scleritis, or inflammation of the sclera, consists in a bluish-red, 
somewhat elevated patch, with implication of the overlying episcleral 
tissue (episcleritis). In the earlier stages pain and photophobia, if 
present, require atropine and boric acid and compresses of hot water ; 
later, the infiltration may be subdued with yellow oxide of mercury 
ointment, associated with massage. If the disease spread and impli- 
cate the cornea and iris, the treatment useful in ordinary iritis is in- 
dicated. In stubborn episcleritis, without iritis, which does not yield 
to these measures, eserine, usually accompanied by pilocarpine sweats, 



SCROFULOSIS. 601 

should be tried, and even the actual cautery has been recommended. 
The disease in many instances is associated with rheumatism, syphilis, 
scrofula, anaemia, and menstrual disorders — these must always receive 
the needed constitutional treatment, especially if iritis or keratitis ensue. 
Scleritis is a disease hard to eradicate and subject to frequent relapses. 



SCROFULOSIS. 

Scrofulosis is to be treated by hygienic measures rather than drugs ; 
fresh air, residence by the sea-side, proper out-door exercise, massage, 
and dietetics, all of which take precedence of medicines. 

If these necessary adjuncts to a cure are obtainable the prognosis 
is fair, to say the least, and the following drugs may be used, all of 
them being devoted to the improvement of the general health, aud 
not to any direct influence over the scrofulous tendency in itself. It 
is hardly necessary to state that cod-liver oil, or its supposed active 
principles combined under the name of morrhuol, is, perhaps, the best 
remedy of all. The oil should be given in emulsion, being first pan- 
creatized and so prepared as to be somewhat palatable, by the addition 
of flavoring substances, if the child is old enough to appreciate such 
flavors. In young children, while distaste to the oil is often shown at 
first, a liking for it rapidly develops, so that the writer has seen chil- 
dren cry for it when the oil was discontinued. It is nearly always 
best to combine the lactophosphates or the hypophosphites with the 
oil when it is given in these cases. Whenever anaemia is present syrup 
of the iodide of iron is useful in from 1 to 10-drop doses, according to 
the age of the child, as follows : 

Be. — Syrupi ferri iodidi . . . . fgssvelf.^ij. 

Aqua? dest q. s. ad f Jiij. M. 

S. — Teaspoonful in water three times a day, after meals, to a child of one year. 

In these same cases fa grain of arsenious acid or the yj-g- grain of 
corrosive sublimate may be given to a child of three or four years, 
in the form of tablet triturates, or the following prescription may be 
used : 

R. — Liquor, potassii arsenitis .... TTL^vj. 

Aquse destillat f^ij. M. 

S. — Teaspoonful three times a day, after food. 

R . — Hydrarg. chlor. corros. . . . gr. -^ vel gr \. 

Aquae destillat fgij M. 

S. — Teaspoonful every five hours, after food. 

The use of the iodides is generally contra-indicated in those cases 
where softening and breaking down of the glands are going on 
rapidly. In their place we may employ the phosphates of lime or 
sodium in from 1 to 2-grain doses several times a day, and if suppu- 
ration is active the sulphurate of calcium, given by placing 1 grain of 
it in half a tumblerful of water and giving a teaspoonful hourly. 



602 DISEASES. 

This mixture should be made fresh every day to prevent its becoming 
oxidized. 

Where enlargement of the cervical glands takes place, iodine oint- 
ment, diluted with one-half of lard, should be well rubbed into the 
part twice daily, but stopped at once if any signs of softening or 
fluctuation appear, or if the skin becomes reddened. Where these 
enlargements are persistent, ichthyol ointment is to be rubbed in and 
ordered as follows : 

B= • — Ichthyol g j vel ij . 

Adipis %]. M. 

S. — Apply locally. 

If this is not followed by a cure, the glands should be excised or 
scraped and the cavity packed with iodoform, as in the majority of 
cases these bodies will be found to be distinctly tuberculous. (See 
Adenitis.) 

SCURVY. 

Scorbutus is caused so frequently by dietectic lawlessness and its 
cure is so completely dependent upon the use of proper foods that 
almost no drugs are to be employed in its treatment. The avoidance 
of all salt meats, or more important still, the avoidance of those foods, 
be they what they may, which have caused the disease in a given case, 
is to be practised. 

The only remedies particularly indicated are lemon-juice or lime- 
juice, or citric acid, the latter being far less valuable in all cases than 
the juice of the fresh fruit. Where lemon-juice causes indigestion, 
this effect may be avoided by boiling the lemonade and allowing it to 
cool. The boiling precipitates certain poisonous and irritating albu- 
minoids and the supernatant liquid when taken away is devoid of 
any evil influence, and may be cooled and sweetened to suit the taste 
of the individual concerned. Arsenic and iron are of service in most 
cases, and rest and quiet are to be insisted upon. 



SHOOK. 

The medical treatment of shock is very important, and the life of 
the patient depends upon the care exercised by the attendant ; but before 
describing the treatment it is in place to consider the causes of the con- 
dition and the state of the injured person, so that we may understand 
the methods indicated. Every physiologist recognizes the fact that the 
body, particularly in its most vital parts, is controlled by inhibitory 
and accelerator nerves or nerve cells, which govern the functions of 
all organs. Normally these two forces of inhibition and acceleration 
act in such a way as to be perfectly balanced, but abnormally they may 
either of them become excessive and overcome the other. Further 
than this, we must remember that all conditions of great functional 



SHOCK. 603 

activity are ultimately followed by a reaction which amounts to de- 
pression or exhaustion. 

Shock consists in an over-stimulation of the inhibitory apparatus 
which governs the heart and respiration, ultimately followed by ex- 
haustion of inhibition, so that the pulse and breathing become rapid 
and shallow instead of slow. Various degrees of shock can be readily 
recognized and the severity of the condition always depends upon 
the constitution of the individual. Everyone has heard a nervous 
woman say : " You frightened me so that my heart stood still," and 
again, a moment after : " Just feel how fast my heart is beating," and 
we all of us know how any severe and sudden shock causes these 
changes to appear in the pulse to some degree. The same mechanism 
is the cause of shock in railway or other injuries, only it is much 
more severe, owing to the actual injury received, and its accompany- 
ing terrors. Many of the readers of this book probably know that 
a violent blow upon the belly wall, just over the solar plexus, will 
cause death, even in so large an animal as the ox, and every boy has 
had the " breath knocked out of him " by a blow of sufficient feeble- 
ness not to be lethal in its influence. When a dog or other animal 
is examined after such a death, the heart is always found in wide 
diastole, because the excited vagus nerve has held it open in diastole 
and prevented contraction until the absence of blood in the brain 
has resulted in death. 

This period of inhibitory excitement, when it occurs in man with- 
out being severe enough to cause death, speedily gives place to inhib- 
itory exhaustion, and we have a rapid pulse from inhibitory palsy, 
while through the palsy of the vasomotor system the bloodvessels are 
relaxed and the normal resistance to the heart is taken away. The 
heart beats wildly and fast for the same reason that a locomotive's 
wheels fly round when the track is slippery — or, in other words, 
normal resistance is lost. 

The capillaries in the second stage of shock are dilated, and the skin 
is relaxed, moist, and cold from excessive dissipation of heat. This 
is the more prolonged stage of the two, but they both need active 
treatment. 

The patient will rarely be seen in the first stage of shock, simply 
because by the time the physician reaches him the second stage will 
have come on. In either event, the principal things to be done are 
the administration of -g 1 ^ to fa grain of sulphate of atropine hypoder- 
mically, and the application of external heat to maintain the bodily 
temperature, the fall of which is a factor of great importance, but gen- 
erallv overlooked in attending to an operation or other measures of 
relief. The use of atropine is peculiarly a triumph of experimental 
therapeutics and rests upon logical deduction. It will be remembered 
that atropine in full dose acts as a depressant to the vagus nerve, and 
as this nerve is over-active in the first stage, the drug acts as a seda- 
tive to it. This is, however, a comparatively unimportant fact, for it 
is another action of atropine which makes it valuable. If the vagus 
be very much stimulated, a safe dose of atropine cannot quiet it, but 



604 DISEASES. 

in the second stage, which we most commonly have to treat, a safe 
dose does not act so much upon the vagus as upon the vasomotor sys- 
tem, and by preventing the dilatation of the bloodvessels of the body 
thereby provides blood-paths of normal tone and tenseness, which do 
not hold all the blood in stagnant pools where it is not needed, but 
carry it to the brain and vital parts. Digitalis is a useful adjuvant to 
atropine in the second stage of shock because of its powerful vasomotor 
and cardiac influence. Twenty drops of the tincture of digitalis 
should be given hypodermically and repeated in an hour if the pulse 
does not show the influence of the drug at the end of that time. 

The application of heat in the form of hot-water cans, hot bricks 
or bottles, must not be forgotten, care being taken that the patient is 
not burned. (See article on Heat, page 360.) 



SMALLPOX. 

The treatment of smallpox is not specific, simply because it is one of 
those diseases which run a given course, aud which we cannot abort. 
We can only treat the various symptoms which present themselves, 
and by the modification of these manifestations prevent complications 
and sequelae to some extent. The fever is to be treated as is any fever 
of this class. Often it can be allayed by a mixture containing tinc- 
ture of aconite, spirit of nitre, and spirit of Mindererus (liquor ammonii 
acetatis), while the headache or backache may be controlled by antipy- 
riue or acetanilide. Mustard plasters are not to be used for the back- 
ache, as the dermal irritation will increase the eruption. Insomnia and 
restlessness, if excessive, are to be quieted by the bromides or chloral, 
care being taken that the doses of the latter are not large enough to 
depress the heart. It must be remembered that the time of onset of 
the secondary fever, the eighth day, is one of grave import to the 
patient. Before its arrival the treatment of the case must be so man- 
aged that strength is saved for this strain, and tincture of the chloride 
of iron, in 5 to 10 or even 20-drop doses, may be resorted to to give 
strength to the patient and to affect specifically the pysemic fever. The 
pulse should be watched, and if it flags, brandy and whiskey should 
be freely but wisely used. At the same time nourishment in the 
shape of eggnog, milk punch, or beef-tea, should be pushed as freely 
as the digestion will allow. 

The peripheral irritation and itching of the eruption are a cause of 
the fever in part, and produce much unrest and nervous irritability. 
The condition of the skin is, therefore, to be looked after, and the pit- 
ting prevented, if possible, by every means in our power, particular 
care being taken to prevent its appearing on the face. One of the 
means which has been recommended to prevent pitting is the use of 
flexible collodion, and another application is glycerite of starch or 
simple cerate applied in a heavy coating. Some physicians recommend 
inserting the tip of a nitrate of silver stick into each vesicle as it rup- 
tures, to prevent pitting. All of these measures are futile in most cases, 



STOMATITIS. 605 

and the use of collodion is probably harmful in some instances. The 
best application to use is made up of 4 parts of salicylic acid to 100 
parts of vaseline or cold cream. Sometimes, anointing the entire body 
with sweet oil slightly earbolized (1 to 100) is useful to check irri- 
tation. 

If the mouth is sore, a mouth-wash of chlorate of potassium and 
water may be used, flavored with a little tincture of myrrh. 

Disinfection, good ventilation, and the avoidance of much light are 
necessary. 

STINGS AND BITES. 

The stings of nearly all small animals depend for their activity upon 
formic acid, and are to be relieved by the use of dilute alkaline liquids, 
or, better still, by the application of ammonia, or, instead, an applica- 
tion of ordinary or flexible collodion may be made, which is improved 
in its action by the addition of 1 part of mercury bichloride to 1000 
of the collodion, or, if preferred, salicylic acid may be added in the 
proportion of 5 grains to the ounce. Sometimes a solution of carbolic 
acid, 1 to 100 or 1 to 50, when sponged over the parts exposed, not 
only relieves the itching of mosquito bites, but keeps away the mos- 
quitoes. In other instances the stings are relieved and cooled by the 
use of dilute or pure vinegar. 

In snake-bite the best treatment is that introduced by Weir Mit- 
chell and Reichert, namely, the local application of permanganate of 
potassium to the part, which should be thoroughly filled with the drug, 
and full doses given hypodermically about the wound, the salt being 
diluted three-fourths with water, and followed by full doses of alcohol 
by the mouth. The secret of successful treatment consists, however, 
in the use of a ligature or a cleansing of the wound as soon after its 
reception as possible, thereby preventing the absorption of the poison. 



STOMATITIS. 

This annoying affection is most commonly seen in children, and 
is characterized by the appearance on the tip and sides of the tongue, 
lips, and lining membrane of the mouth of small spots which some- 
times have a reddened zone around them, and which result in minute 
or large ulcers. 

The best treatment, if the kidneys are not acutely inflamed, is the 
use of the following prescription, which largely depends for its value 
upon the potassium salt used : 

r*. — Potassii chlorat 3J- 

Tinct. myrrh . gtt xx. 

Elixir, calisayse f^iij- M. 

S. — Teaspoonful in water every four hours. 

As the chlorate of potassium is eliminated with the saliva, it not 
only does good when taken into the mouth, but is active all the time 



606 DISEASES. 

that it is being eliminated. If the stomach is disordered, the same 
preparation may be used as a mouth- wash. Often constipation will 
exist, and it should be removed by salines or by rhubarb in the form 
of the aromatic syrup. Another remedy which is very efficient in 
stomatitis is borax, used as a mouth- wash, in the strength of 10 to 15 
grains to 1 ounce of water and honey, as follows : 

R • — Sodii boratis gr. xxx. 

Mel purificati . . . . . . f^iij. 

Aquse q. s. ad f Jiij. M. 

S. — To be used on a swab or as a mouth-wash every four hours. 

This also may be used internally in adults. 

In many cases peroxide of hydrogen in the proportion of 1 ounce 
of a fifteen-volume solution to 8 ounces of water proves a valuable 
mouth-wash. 

If the liver is at fault and is torpid, nitro-muriatic acid is useful, 
and when the spots do not readily yield to treatment they may be 
touched with the tip of a stick of silver nitrate — which, while it is 
momentarily painful, is very efficacious. 

Nearly always with this disease in childhood there is considerable 
fever, vomiting, and wakefulness at night, with fretfulness aud crying 
during the day and total refusal of food, not because hunger is absent, 
but because the food hurts the mouth and is rejected with a cry of 
pain as soon as it touches the lips. The food should be very soft milk 
toast for older children, or milk with lime-water in it in large amount 
for infants fed by the bottle. If a child at the breast be attacked, the 
mother's nipple should be carefully washed with boric acid solution 
after each nursing. A warm foot-bath at night is often necessary to 
produce rest, and 10 drops of sweet spirit of nitre thoroughly diluted 
may be given with advantage to a child of one or two years. If the 
irritability of the nervous system is excessive, bromide of sodium or 
potassium in the dose of from 1 to 10 grains, according to age, three 
times a day, is of service, and may be added to the mixtures already 
named, or better still, given alone. 

After the attack is past, tonics and a carefully selected diet are 
generally necessary. 

STYES. 

Styes consist in a localized inflammation of one of the glands in 
the margin of the lid or the surrounding connective tissue. Before 
suppuration is established abortive treatment may be practised by an 
inunction with a salve of the red or yellow oxide of mercury (8 grains 
to 1 drachm), by painting the surface with an ethereal solution of 
collodion, or, according to Abadie, by the application of a saturated 
solution of boric acid. Pain may be alleviated with hot compresses 
(water 110° F.), frequently changed, and as soon as pus appears 
incision is necessary. Associated conjunctivitis requires a boric acid 
solution for its relief. It should be remembered that styes indicate 



SUNSTROKE. 607 

ill health, that tonics are indicated, and that they most frequently 
appear in the subjects of refractive error. When they tend to come in 
crops, the internal use of sulphurate of calcium has been recommended. 



SUNSTROKE. 

Sunstroke, or, more correctly speaking, heat-stroke, is an affection 
produced by exposure of the body to any form of high temperature, 
whether the source of heat be the sun, a furnace, or the radiation of 
heat from the earth. For this reason the condition may occur as 
readily at midnight as at mid- day. 

Heat-stroke is to be divided into two classes, in one of which ex- 
cessive exposure to heat upsets the balance of the thermal mechanism 
of the body so that fever comes on (thermic fever), in the other the 
temperature is lowered, and forms the condition known as heat- 
exhaustion. 

The condition of thermic fever is very frequently seen, while heat- 
exhaustion is rare. 

The danger of thermic fever is that the excessive heat may cause 
coagulation of the myosin in the heart muscle and of the protoplasm 
in the brain, and cause death, or that the same result may be reached 
by paralysis of respiration. 

The danger of heat-exhaustion is that death may ensue from collapse 
due to a general failure of vital power aud the chilling of the body. 
In heat-exhaustion, too, the vascular system is greatly relaxed and 
depressed, and the circulation is at its lowest ebb. 

The treatment of these two states is, of course, radically different. 
When a patient has thermic fever, and is brought under the care of 
the physician, the first thing to be done is to loosen the clothing — if 
possible, remove it — at the same time applying cold to the body, and 
particularly to the abdomen, back, and chest. Better still, the man 
should be stripped, laid upon a bed, which must be covered with a 
rubber blanket, and ice-water be applied to the body by means of a 
sponge, or a piece of ice may be laid on the belly, while another piece 
is rubbed over the rest of the body. While this is being done the 
surface of the patient's body must be thoroughly and briskly rubbed 
in order to bring the hot blood to the cooled surface. 

Care should be taken that the temperature, when it once begins to 
fall, does not drop suddenly below the normal and cause collapse. If 
the clinical thermometer in the mouth or rectum shows that the 
temperature has fallen to 100.5° F. or 101° F., the cold applica- 
tion should be stopped, and the patient allowed to lie on the bed 
covered with a thin sheet only. The bodily temperature must be con- 
stantly watched, as it will probably bound up again in a few minutes, 
and require the application of more cold, used with the same care. 
This second rise is due either to the disorder of the nervous mechan- 
ism of heat production and dissipation, or to the fact that, while the 
surface of the body is cooled by the ice, the innermost viscera are still 



608 DISEASES. 

in high fever and rapidly heat the surface as soon as the ice is taken 
away. Antipyretics have been found to be almost useless in the hyper- 
pyrexia of sunstroke, and, at their best, are not to be relied upon. 

After the fever has been reduced permanently, the danger is not all 
passed, and it is the greatest mistake to discharge a patient as cured at 
this time. After two or three days it is very common for a meningitis 
to develop, accompanied, it may be, by little or no fever, but char- 
acterized by violent darting headache, which is made worse on lying 
down or on sudden movement. The treatment of this state must be 
bold, and venesection is the only safe method of obtaining relief, 
although vascular sedatives, such as veratrura viride, may be employed. 
The bleeding should be copious enough to impress the circulatory 
system to some degree, and may be done by opening any of the promi- 
nent veins in the arm. (See Venesection.) Sometimes a violent attack 
of epistaxis saves the man's life, when it would have been lost through 
the ignorance of his attendant. If life is preserved without vascular 
depletion, secondary changes in the brain may ensue and produce 
hemianopsia, optic atrophy, imbecility, or insanity. Quinine, salicylic 
acid, and similar substances, are all contra -indicated under these cir- 
cumstances, because of the congestion of the meninges to which they 
predispose by their physiological effects. 

The treatment of heat-exhaustion consists in the use of heat instead 
of cold, in order to restore the bodily temperature. Just here, however, 
must be uttered a word of warning, namely, that the mere fact that 
the skin is cold does not prove the case to be one of heat-exhaustion, 
since a rectal thermometer may show the central or real temperature 
of the body to be iu a condition of hyperpyrexia. Of course, such a 
case should not receive hot, but cold rectal injections, if the symptoms 
require it. 

The bodily heat in heat-exhaustion is to be raised by placing the 
patient in a bath at 105° to 110°, or by the use of hot bricks or 
bottles, care being taken that they do not burn the patient. The 
bodily temperature should also be watched, lest the other extreme of 
heat be reached. 

Cases of heat-exhaustion are not so apt to have meningitis as are 
cases of sunstroke, but they are generally slow to convalesce, and 
require tonics and careful watching for a long time. Indeed, in many 
instances, the system seems to receive a shock from which it takes 
several weeks or months to recover. 



SYPHILIS. 

In so far as the choice of drugs is concerned, the treatment of 
syphilis is exceedingly simple : iodine, iodide of potassium, and mer- 
cury practically represent the only remedial agents which are well 
proved to possess the power of distinctly counteracting the effects of 
the disease. 

In regard to the method of administration, and the period of the 



SYPHILIS. 609 

disease in which any or all of these drugs can be given to the best 
advantage, there is a wide diversity of opinion. Following the 
teaching of Fournier, in this country the practice generally obtains 
of administering mercury on the appearance of the first symptoms of 
the secondary stage of syphilis ; this drug is continued for from 
twelve to eighteen months, and is then followed by a course of iodide 
of potassium continued for from six to twelve months. If, after the 
suspension of this treatment for six months, no manifestations of dis- 
ease appear, the patient is regarded as cured. Should the disease 
again break out, the iodides are administered in increasing doses, sup- 
plemented by the addition of mercury if necessary. 

Against this treatment, however, there have been many and vigor- 
ous protests. Every syphilographer knows that the disease is fre- 
quently self-limited. Zeissl states that a large number of cases pro- 
gress to spontaneous cure, and that the secondary eruption in such 
cases disappears in from two to eight months, after which time the 
patient is perfectly well, recidivity being far less common than when 
mercury has been employed in the early stages of the disease. The 
treatment by iodides, he thinks, should be commended chiefly after 
the expectant plan ; their effect is not so rapid as is that of mercury ; 
they are suitable, however, to all stages of the disease. When the 
symptoms become so urgent that it is no longer safe to depend upon 
iodides, mercurial inunctions should be employed, the dosage of the 
drug being regulated by its effect upon the symptoms, in all cases the 
minimum quantity necessary to accomplish the result being adminis- 
tered. 

We have, then, three methods of treatment proposed, each advo- 
cated by a formidable array of authorities : 

1. The expectant treatment. 

2. The treatment by iodides, followed, if necessary, by mercury. 

3. The continued treatment, beginning with mercury, and ending 
with iodide or the combination of the two drugs. 

By the expectant treatment is implied abstinence from all medica- 
tion intended to directly counteract the syphilitic virus ; if possible 
the patient should lead an active, out-of-door life, the diet should be 
most carefully regulated, and the treatment should be purely symp- 
tomatic, tonics being administered when required, the sore-throat 
being combated by astringent gargles, particularly those coutaining 
chlorate of potassium or malic acid,, together with direct local applica- 
tions, while the eruption on the exposed parts of the body is con- 
trolled by the application of heat. The objection to this treatment 
lies in the long persistence of the secondary eruption. Where the 
primary lesion is large and persistent ; where the period of secondary 
incubation is less than seven weeks ; where the papular eruption is 
universal, is confluent, and is accompanied by the simultaneous ap- 
pearance of mucous patches; where the lymphatic enlargement is 
very marked and persistent ; and where the disease attacks a depraved 
constitution, the expectant plan offers little hope of accomplishing a 

39 



610 DISEASES. 

cure. Here the second and third methods of treatment are clearly 
indicated. 

By the second plan of treatment the iodides are administered, not 
immediately on the appearance of the secondary eruption, but after 
this has run a course of several weeks, and is steadily increasing in 
severity. The iodide of potassium is chosen by preference, beginning 
with the administration of 5 grains, three times a day, and increasing 
steadily 5 grains a day until either the constitutional effects of the 
drug are manifested or the symptoms are favorably influenced. Should 
iodism appear, the dose is cut down one-half, and continued for one 
or two weeks, after which, if the syphilitic lesions are not favorably 
modified, inunctions of mercury are employed, a drachm of mercurial 
ointment being rubbed in every other day. The iodide should be 
continued for from six to twelve months after the disappearance of all 
symptoms, relapses being combated by temporarily increasing the 
dose and by a course of mercurial inunctions. If after the suspension 
of the treatment the patient remains free from all manifestations of 
syphilis for two years he can be fairly considered as cured. 

By the third method of treatment, and this is the method most 
commonly accepted in practice, the patient is placed upon mercury 
the moment the early secondary symptoms denote that the primary 
sore was surely syphilitic. Many surgeons begin this treatment from 
the time that the inguinal glands on both sides become characteristic 
in shape and size. Others wait until there is general lymphatic in- 
volvement, while others believe that the mercury should not be 
administered until roseola appears. 

In regard to the particular preparations of mercury to be em- 
ployed, the protiodide, blue mass, bichloride, and the mild chloride 
represent the forms usually employed when the drug is administered 
by the stomach. Of these the protiodide is to be preferred, and the 
effort of the surgeon is directed first toward determining what is 
termed the " tonic " dose. With this end in view, \ grain of the 
protiodide of mercury is given, in pill form, three times a day ; and 
every second day this quantity is increased by one pill, the patient 
being meanwhile carefully watched. The drug usually manifests its 
physiological effects by griping pains accompanied by two or more 
watery passages from the bowels, or by foetid breath and slight ten- 
derness of the gums. The quantity taken to produce this effect 
represents the extreme limit to which it is safe to push the drug. If 
this dose is continued or increased the characteristic symptoms of 
mercuric saturation appear. When the surgeon has determined the 
limit to which the drug can be safely pushed, this dose is cut down 
one-half, and, in the absence of further complications, the patient is 
directed to continue this treatment for eighteen months. If, during 
this time local symptoms appear, which show that the disease is not 
thoroughly under control, the mercury must again be pushed to the 
full dose, being reduced to the tonic dose as soon as the disappearance 
of specific lesions permits of this. Where comparatively small doses 
of the protiodide produce pain and purging, opium may be added ; in 



SYPHILIS. 611 

this' case the breath and the mouth will show when the full effect of 
the medicine is obtained. Manifestations of the disease occurring 
during mercuric treatment must receive local treatment. The surface 
eruption is combated by mercuric ointments and washes, and by the 
application of heat. (See Heat.) Mucous patches in the mouth are 
quickly healed by applications of solid nitrate of silver or sulphate of 
copper, 20 per cent, chromic acid solution, or the acid nitrate of mer- 
cury. When these patches occur about the genitals, washing with 
1 : 2000 bichloride solution and dusting with calomel and bismuth 
will be found satisfactory. Alopecia is combated by shampooing and 
by the application of strong stimulating lotions containing croton oil 
or tincture of cantharides. 

The intense cephalalgia is combated by ^ grain doses of calomel, 
repeated every two hours. The periostitis yields most readily to 
gentle long-continued mercuric inunction, supplemented by the appli- 
cation of pressure bandages. 

When the integrity of any vital organ is threatened there should 
be no hesitation in pushing the mercury treatment and in supplement- 
ing it, if favorable results do not follow promptly, by large doses of 
iodide of potassium. 

After the first eighteen months iodide of potassium is generally in- 
dicated. This is commonly given together with the mercury, consti- 
tuting the mixed treatment. The following formula, or one similar to 
it, may be employed : 

R=. — Potassii iodidi .^ij vel ^iv. 

Hydrarg. chlor. corros. .... gr. ss. 

Syrup, aurant cort. . . . . . f^j. 

q. s. ad f Jij. M. 



S. — Teaspoonful three times a day. 

When this prescription is put up, a precipitate is formed and then 
dissolved, and an exceedingly useful mixture is prepared. 

This mixture, or iodide of potassium without the mercury, admin- 
istered in 5 to 10 -grain doses three times a day, is given for from six 
to twelve months longer. When the iodide is given alone it is most 
conveniently administered in the form of a saturated solution. Of 
this a drop contains a grain of the salt. Milk seems to have the 
power of completely disguising the disagreeable taste of the drug. 
Thereafter, specific treatment is stopped, unless symptoms arise, in 
which case it should be renewed, and should be continued for many 
months. 

The protiodide is usually preferred, because the symptoms of its 
constitutional effect are manifest at first in the bowels, and because, 
in practice, it has been found one of the most satisfactory of all 
preparations. Where this form of mercury is not well borne, the 
physician should at once employ some other salt ; the bichloride, in 
y 1 ^ grain doses three times a day, is efficacious. Blue mass will often 
act favorably when other preparations cannot be tolerated. Its com- 



612 DISEASES. 

bination with iron is desirable, and the following formula represents 
one of the most valuable of the antisyphilitic pills : 

K . — Mass. hydrargyri gr. xxiv. 

Pulv. ferri chloridi gr. xij. M. 

Ft. in pil. no. xii. S — One three times a day. 

Where mercury cannot be administered by the mouth it may be 
given by means of vapor baths, by inunctions, and by hypodermic 
injections. The vapor baths are useful when it is desired to promptly 
cure eruptions on the surface of the body, or when it is most impor- 
tant to bring the disease quickly under the influence of mercury. 
They are readily administered, the only apparatus required being an 
alcohol lamp, and a plate in which the mercuric preparation can be 
volatilized. The patient is seated in a chair entirely naked, several 
blankets are wrapped around his neck, and beneath the tent thus 
formed a large vessel of steaming water is placed. When the skin 
is thoroughly softened J drachm of calomel is sublimed by means of 
the lamp. These baths may be repeated every night until the mer- 
curic foetor of the breath is observed, or until the specific symptoms 
disappear. (See article on Mercury.) 

Inunction represents the most efficient way of administering the mer- 
curic treatment. When the stomach is intolerant of drugs, or when, 
administered by the mouth in full doses, they do not favorably modify 
the symptoms, inunctions are indicated. The patient is instructed 
to take a warm bath, and the mercury is then well rubbed in over the 
inner surface of the forearm and arm, the axilla, and along the side 
of the chest, for fifteen minutes. Either the oleate of mercury, 10 
per cent., or the ordinary mercury ointment is commonly employed ; 
the former is somewhat more cleanly. The rubbings should be done 
by the patient, should be made over a large surface of the body, and 
should be performed thoroughly ; 1 drachm of blue ointment is 
rubbed in daily. A shirt kept for this purpose is then put on next 
to the skin, and the ordinary clothing is worn over this. The next 
night the opposite arm and side of the body are utilized as the seat 
of inunction; the following night the right groin and the inner sur- 
face of the right thigh and leg ; next, the same regions of the oppo- 
site side of the body ; finally, the anterior surface of the chest and 
abdomen. In this way irritation of the skin is avoided. Where it 
is impossible to employ the inunctions in this way another means of 
causing absorption of mercury through the skin, suggested by Sturgis, 
will be found satisfactory. After a thorough soaking of the patient's 
feet in hot water, from \ to 1 drachm of a 20 per cent, oleate of mer- 
cury is rubbed vigorously into the sole of one foot ; the next night 
the sole of the other foot is treated in the same way. The patient 
is directed to wear, night and day, a pair of woollen socks ; these are 
not changed for one week. Mercury may be taken by the mouth at 
the same time inunctions are employed, when it is desired to influence 



TETANUS. 613 

the system quickly. In the late periods of the disease very striking 
effects are often obtained by supplementing the iodide treatment by a 
course of twelve to eighteen inunctions. 

The hypodermic administration of mercury is, in this country, 
limited to those few cases w T hich do not seem to respond to the drug 
when given by the mouth or for absorption through the skin. 
Although many preparations of mercury have been lauded as most 
efficacious w T hen used hypodermically, the best formula seems to be 
that recommended by Hebra. This consists of a solution of one per 
cent, of bichloride of mercury in a six per cent, sodium chloride 
solution ; the resulting mixture is perfectly clear and is readily pre- 
pared. If it becomes turbid it should be thrown away. Most rigid 
antiseptic precautions must be observed, as abscess formation is not 
uncommon. One injection is given daily, from -^ to ^ grain of the 
sublimate being administered. The nates are selected as the seat of 
the injection, the solution being driven well into the muscles of each 
side every other day. Twenty injections are usually sufficient to 
cause the disappearance of all symptoms. The employment of the 
insoluble preparations of mercury, particularly of calomel, gives 
much pain, frequently causes abscess, and is, at times, attended by a 
continuous absorption, which may produce severe and even fatal 
ptyalism. 

The ulcerations often found as tertiary manifestations of the dis- 
ease are treated according to general surgical principles. The local 
application of mercuric preparations is of less service than during 
the existence of the secondary lesions. Iodoform is peculiarly ser- 
viceable. 

The tonic and general treatment of syphilitic cases must not be 
forgotten ; fresh air, exercise, bathing, careful diet, regular living, all 
must be enjoined. Moreover, in certain cases where there is marked 
ansemia or physical weakness, cod-liver oil, stimulants in moderation, 
compound syrup of the hypophosphites, and other tonic and nutritive 
courses of treatment, must be carefully carried out. 

Although the treatment of an ordinary case of syphilis is simple 
and satisfactory in its results, it must be remembered that there are 
malignant forms of the disease, attacking by preference feeble and 
cachetic individuals, running a rapid and virulent course unchecked, 
nay aggravated, by specific treatment, and responding feebly, if at 
all, to the most careful hygienic and tonic regimen. 



TETANUS. 

The treatment of tetanus is quite independent of its causation, so 
far at least as drugs are concerned, and it is virtually identical with 
that of strychnine poisoning, to which the reader is referred. It is 
stated that Fowler's solution acts almost as a specific in some cases. 
(See Xux Vomica.) 



614 DISEASES 



TUBERCULOSIS. 

Under this head will be considered pulmonary tuberculosis as a 
type of all forms of this morbid process. Its treatment may be 
placed in two lines — the first devoted to the cure of the disposition 
or inclination toward the disease, or the abortion of its early stages ; 
the second directed to the improvement of the patient's condition, so 
that his progress through the disease may be made as comfortable as 
possible. Before doing this, however, it is proper to state that 
prophylaxis, or true prevention, is the object really to be sought after. 
Recent studies have shown most conclusively that tuberculosis is 
capable of being transmitted from man to man or from husband to 
wife, if the air laden with the bacilli is breathed, and if the lungs 
are in a fit state of depressed vitality, from any cause, to afford a 
favorable field for the growth of the germ and the development of 
its poison. 

Cases of pulmonary consumption follow, rudely speaking, three 
well-defined lines. A very early stage sometimes comes to the care of 
the physician, and it is that in which the following history is given, 
or a similar story is elicited. A patient, previously strong and well, 
or of poor health, as the case may be, begins to lose vivacity. Life 
becomes a burden and exercise is distasteful. A slight daily chill, in 
morning or evening, and fever develop, and the phyiscian who is care- 
less treats the case as one of mild malarial poisoning. Careful exam- 
ination, however, will show an area in the lung, generally near the 
apex on either one or both sides, where slight prolongation or expira- 
tion with a harsh inspiratory sound is heard, and where percussion 
will give impaired resonance or duluess. In other words, the first 
stage of phthisis is present, and the physician must resort at once to 
those active measures for the patient's relief which will be considered 
in a moment. 

In another form a chill, a sweat, a sudden loss of flesh and vigor, 
with, more prominent than all, a hard cough, sudden in its onset 
and rapidly becoming excessive with profuse expectoration, are the 
dominant symptoms. The wasting is extraordinary, the sweats are 
constant, and death may come in one or two weeks. This is the 
form known as " galloping consumption." 

The third variety is ushered in by a gradual loss of vigor or a 
sensation of being a little unwell, or is brought before the patient's 
mind by a sudden acute haemorrhage or several haemorrhages rapidly 
succeeding one another. This variety drags out its course more or 
less rapidly. Sometimes death soon ensues from a fatal haemorrhage, 
in other cases the disease keeps on for months and the case dies from 
exhaustion. 

Last of all, the fourth class is made up of persons who gradually 
pass from bad to worse. First, they " catch a cold," which hangs on 
longer than it ought, and, as soon as they are well, this is followed 
by another one which is found more difficult to cure, until finally there 



TUBERCULOSIS. 615 

is always a cough. Soon wasting comes on, strength is lost, and a 
long period of months or years ensues during which the progress of 
the case is now slow, now fast, the condition now better, now worse, 
until death ensues from wasting or pneumonia, or some other compli- 
cation. 

These forms and stages have been roughly outlined, so that a dis- 
cussion of their treatment might be taken up with a clear idea of what 
is to be done. 

When a patient exhibits those physical signs which have been given 
as evidences of the early beginnings of phthisis, the physician should 
institute certain hygienic and medicinal measures. If the individual 
be earning a livelihood by following some confining occupation, this 
occupation must be given up and one undertaken which is carried on 
in the open air and yet not accompanied by too great exposure. Even 
if exposure is incurred it is better than the occupation previously fol- 
lowed : thus, if the patient be a bookkeeper, a printer, or a bookbinder, 
or a clerk kept much at a desk in an ill- ventilated room. A few wet- 
tings in the rain will do little or no harm, if properly treated by the 
wearing of flannel shirts, which, when wet, are changed as soon as labor 
ceases, as under these circumstances the danger of catching cold is at a 
minimum. If the case is wealthy enough to be able to obtain a change 
of climate and to stop all labor, only taking exercise for pleasure or 
health, a change is, of course, of value. Some of these patients do 
best in a high, dry air, and others in a lower and more moist tempera- 
ture — the first being represented by that of Colorado and Saranac 
Lake in the Adirondacks, the second by that of Florida. 

In the majority of cases, however, some more moderate, or half and 
half, climate is useful, and this can be obtained in Lower California, 
as at San Diego, a place w T here there is virtually perpetual summer. 
In other w r ords,a spot is desirable where a patient can remain the year 
round, and, if well enough, engage in business, avoiding the cold, 
sharp March winds of the Middle, Eastern, or Northwestern States 
and the necessity of leaving Florida on the advent of summer. 

Physicians have attempted for years to formulate rules for phthis- 
ical patients as to the climate to be sought. In the majority of cases 
the various health-resorts have to be chosen by experiment, not by 
judgment beforehand. It is probably true, however, that high alti- 
tudes and rarefied air are not to be sought where a distinct tendency 
to haemorrhage is present, unless the ascent or removal to the rarefied 
air is very gradual, several weeks being passed before the lung is ex- 
posed to the low pressure of great heights. 

The following excellent and concise advice, given by Dr. W. Hale 
White, in his book on General Therapeutics, 1 is so worthy of repeti- 
tion that it is inserted here. He says : " It is of such importance 
that only suitable cases should be sent to high altitudes, that we must 
point out those that are unsuitable : 

" 1. Those in w^hom there is considerable affection of the bronchial 

1 A text-book of General Therapeutics. Macmillan & Co., London, 1889. 



616 DISEASES. 

tubes ; for the dryness of the climate increases the kind of bronchitis 
which commonly accompanies phthisis. 

" 2. Patients with much emphysema or bronchiectasis ; because of 
the probably diminished absorption of oxygen and the difficulty of 
respiration experienced on first arriving. 

" 3. Patients with disease of the heart must not go to a high altitude, 
because of its effect upon the pulse and upon respiration. 

" 4. Cases liable to acute febrile attacks, whether or not these indi- 
cate an occasional increase of mischief in the lungs, should remain on 
a low level. 

" 5. Patients who are very excitable or suffer from insomnia should 
not go, for a visit to a place at a great elevation promotes these symp- 
toms. Women do not acclimatize so well as men. 

" 6. Cases in which there are very extensive lesions, or which are 
very advanced, are unsuitable. 

" 7. Pneumonic phthisis, if at all acute, is made worse by a high 
altitude. 

" 8. Patients who cannot take exercise should not go. 

" 9. The very old and the very young had better be treated at home. 

" 10. Sir Andrew Clark states that patients who go to Alpine health 
resorts suffering from albuminuria, or those who develop it whilst 
there, seldom derive any good from their change. 

"There are many conditions which have been thought to contra- 
indicate this treatment, but which do not, and they had, therefore, 
better be mentioned. They are : 

" Pulmonary Haemorrhage. — It is now known that this, so far from 
being a contra-indicatiou to treatment by high altitudes, is actually 
relieved by it. The exact explanation cannot be given." 

(With this the author of this book cannot agree.) 

" Fever. — If this is not excessive, and if it does not indicate any 
active changes iu the lungs, it is often decreased. 

" Simple Diarrhoea and Simple Dyspepsia. — These are both benefited. 

" Night-sweats. — There is a common belief that these forbid this 
treatment ; on the contrary, they often disappear on removal to a high 
altitude. 

" The presence of Cavities. — This is not a contra-indication, unless 
a very large area of lung is destroyed. 

" There is no need, after these lists, to say what cases are suitable 
for this climatic treatment ; it may, however, be observed that those 
in which there is threatened phthisis, with a strong hereditary predis- 
position, and those of imperfect thoracic development, are much bene- 
fited. According to most authorities, it cannot be too strongly urged 
that, so long as the condition and disease of the patient allow the re- 
verse indications to be neglected, a mountain climate should be tried." 

To these rules the author would add the following invariable one, 
viz., Do not send a case away to die. If the disease is so far ad- 
vanced that no good can be derived from a trip abroad, it is cruel to 
make a wretched patient exhaust his strength, his money, and his 
happiness by seeking that health which it is impossible for him to 



TUBERCULOSIS. 617 

obtain. A patient of the writer's returned on one occasion from a 
stay of a few days at a noted Southern resort for consumptives, and, 
when reprimanded for his imprudence, replied : " Doctor, I would 
rather be at home, and die at once, than drag out a few more years 
surrounded by a crowd of coughing, hawking, and wasting consump- 
tives." This reply clearly evidences the necessity of these cases 
avoiding " consumptive resorts" as much as possible, and of directing 
the mind of the patient from depressing thoughts and his own ail- 
ment. 

The medicinal measures to be carried out in all cases of phthisis, 
except that known as the galloping form, are not numerous if we con- 
fine ourselves to the modes possessing any real value. For many 
years cod-liver oil has been sadly abused in the management of these 
cases and has been given at all stages, owing to ignorance of its proper 
use as a general rule. The writer believes that the following rules 
are never to be departed from : 

1. Never use cod-liver oil where the disease has passed the primary 
stages of thickening of the lung and roughening of the respiratory 
sounds, unless fibroid changes are going on, and the changes are very 
slow indeed. 

2. The use of cod-liver oil when rapid degenerative changes are 
occurring in the lung is distinctly harmful, as it is not of any service, 
disorders the digestion, and destroys the appetite. 

When the oil is used it should be given as directed in the article 
on Cod-liver Oil. 

A remedy of much value as a curative and of great value as a pal- 
liative is creasote, first introduced by Bouchard some thirteen years 
ago, but only recently widely employed. Many cures have been 
claimed from its use in the early stages of phthisis and it has been 
highly lauded by a number of European clinicians. In the author's 
experience it is merely a palliative to the cough and general discom- 
fort, at least after the disease is really established, and the opinion 
expressed by Striimpell expresses so well the thought which the author 
was about to write when he read Strumpell's article that his words are 
here given : "Taking it all in all, we find that creasote, even in large 
doses, has no injurious effect in tuberculosis At times we notice an 
apparently favorable symptomatic effect. We failed, however, to 
observe any real influence exerted by creasote on the progress of the 
disease." 

When creasote is used internally it is best given in the following 
formula : 

R. — Creasoti (beechwood) . . gtt. xxxij vel f^j 
Tr. gentian. ...... f^j. 

Alcoholis . . ! . . . • f.^j 

Vin. albse q. s. ad f^iv. M. 

S. — Teaspoonful in water, or wine, three times a day. 

Often a 1-drop dose three times a day may be increased to 5 drops 
in the same period with advantage, and if given in ascending doses I 
have frequently had patients take as much as 90 minims a day, by 



618 DISEASES. 

using a little more of the mixture each time it is taken. Sometimes 1 
or 2 drops in capsules are as useful as the formula just named. (For 
methods of administration, see Creasote.) 

Creasote may also be inhaled in the spray from a steam atomizer 
or by means of an inspirator fitted over the nose and mouth and 
made of perforated zinc with a sponge at the edge to hold the drug. 
A very good inhalation is to wet the sponge with creasote, alcohol, and 
water, equal parts, or to use the creasote alone if coughing is not too 
severe. Another useful mixture consists of equal parts of terebene, 
iodide of ethyl, and chloroform. This last mixture is most useful 
when the secretion is tough and tenacious, and should not be used in 
the presence of acute irritation due to inflammation. These inhalers 
are very cheap, not easily broken, and readily worn. 1 

If the cough in phthisis is excessive, a little spirit of chloroform 
placed on the sponge of the inhaler will often relieve it, or a mixture 
of morphine and wild-cherry bark may be used as follows : 

H. — Morphinse sulph. . . . gr. j vel ij. 

Syr. pruni Virginianse . . . . fgiij. M. 

S — Teaspoonful every three hours. 

Or, the following : 

li . — Potassii cyanidi .... gr. j vel ij. 

Morphinse sulph. . . . gr. j vel ij. 

Syr. pruni Virginianse . . . . fjiij. M. 

S. — Teaspoonful every four hours. 

Very often during the course of phthisis, localized spots of pleuritic 
inflammation arise. Without the occurrence of any exposure the 
patient will remark, " Doctor, I think I have taken a little more cold, 
and I have a stitch here in the chest." The best treatment is to apply 
a small blister or to paint the spot with iodine. 

(For the treatment of Haemoptysis, see Haemorrhage.) 

Laryngeal phthisis, one of the most serious complications of this 
disease, is best prevented by ordering the patient to inhale the steam 
arising from boiling water which contains corrosive sublimate in the 
proportion of 1 to 10,000. If a proper watch is kept for evidences of 
a general mercurial effect and this measure stopped at once when 
tenderness of the gums appears, no danger exists. Before the inhala- 
tion takes place, a spray of cocaine (4 per cent, solution) should be 
thoroughly used. 

The treatment of laryngeal phthisis itself is various. The best 
method is that in which lactic acid is used. By the aid of a laryngeal 
mirror and a cotton applicator a 10 per cent, solution of lactic acid is 
applied to the spots which are involved. As this is generally quite 
painful, cocaine solution should first be used. Gradually the strength 
of the lactic acid solution should be increased to 60 per cent, if the 
weaker solutions do not check the disease. Very valuable results 
have been obtained by this method. 

The second method in point of value is that of iodoform insuffla- 

1 They may be obtained from H. K. Mulford & Co., of Philadelphia. 



TYPHOID FEVEE. 619 

tions. A powder of iodoform alone is too light for satisfactory pro- 
pulsion into the larynx, and powdered talc should be added to it in 
small amount, as may also -fa grain of morphine to each drachm of 
iodoform. The odor is generally disagreeable to the patient, but if a 
cocaine spray be first employed and the operator is skilful, very little 
coughing is produced. As iodoform is a local anaesthetic it relieves 
the pain in the larynx, acts as an antiseptic and alterative, and is 
peculiarly obnoxious to the bacillus tuberculosis. 

When the night-sweats are very violent, hypodermic injections of 
atropine in the dose of -g 1 ^- to fa grain are useful in some cases, and the 
efficiency of this treatment may be increased by the use of an alum 
sponge-bath at bedtime. A solution of alum 10 to 20 grains to the 
ounce may be sponged over the body, or sulphuric acid may be added 
to water in the proportion of 1 drachm to the pint, and used in the 
same way as the alum solution. 

Sulphuric acid is often given internally in these cases with advan- 
tage Small doses of pilocarpine amounting to 2V grain, given from 
one to two hours before the sweat is expected, are sometimes potent 
for good. The means by which this result is brought about are not 
hard to seek. The drug in any dose causes great stimulation of the 
peripheral ends of the nerves supplying the sweat-glands. In many 
instances we find excessive secretion dependent upon depression of 
function, as in a serous diarrhoea or a local sweating of the feet. 
These states pass away just as soon as the parts regain their normal 
tone through proper treatment. The night-sweats of phthisis are 
improved by pilocarpine, because this drug in all doses stimulates the 
sweat-glands. In large doses this stimulation amounts to free dia- 
phoresis ; but in the minute doses such as fa to -fa of a grain, the 
stimulation just balances the depression, and a normal tone is acquired. 
While it is true that pilocarpine and atropine are physiological antago- 
nists, it will be found practically beneficial to prescribe small doses of 
both in such cases as refuse to respond to either one alone, as by their 
antagonism they prevent over-action on other parts of the body, and 
both act in harmony in so influencing the sweat-glands as to be of 
service to the patient. Camphoric acid in 20 to 30-grain doses is 
invaluable in treating night-sweats. 



TYPHOID FEVER. 

Any attempt to review the treatment of the disease known as 
typhoid fever would be absolutely impossible, owing to the very 
numerous theories and practices put forward by various clinicians. 
What is said under the general heading of Fever, and under the con- 
sideration of Cold, also under Antipyrine and Acetanilide, gives a 
sufficient indication as to the treatment of febrile movements ; and the 
care of the patient beyond this point, in nearly all cases, depends 
upon the severity of the attack. 

Before going further, however, the writer desires to insist very 



620 DISEASES. 

strongly upon one fact, namely, that a case of typhoid fever is not 
curable in any degree. No remedy yet found, except it act through 
the prevention of complications, can shorten its course. We can only 
guide the patient safely to health when the storm of disease comes on, 
and we cannot stop the storm. 

Not only should the facts of the last paragraph be carefully borne 
in mind, but the physician must remember that he is treating an ex- 
hausting disease. Not a disease which runs a violent course for a 
few days and strands the patient sick and weak, but convalescent, 
upon the shores of health, but one in which, after sapping his 
strength for weeks, some sudden intercurrent malady or accident may 
ensue which will speedily kill him if every possible grain of strength 
is not preserved for the struggle. The physician should always put 
every case in which there is a suspicion of typhoid fever to bed at 
once and keep him there till the disease has passed or fails to appear. 
Every muscular movement unnecessarily made is a waste of force, 
and, in consequence, everything should be done for the patient and 
not by him. A bed-pan should always be employed, the patient not 
being allowed to sit erect upon a commode. Remembering, too, the 
force consumed in difficult digestion, the food should be liquid, free 
from fat, and consist solely, if not entirely, of milk, and during con- 
valescence, of an egg or a little arrowroot or corn-starch. Not only 
is this recommendation practically correct at the bedside, but it is 
well based on scientific fact, for Brieger has shown that typhoid 
bacilli do not readily reproduce themselves and their poisons in pep- 
tone and well-digested milk, but do so very actively in meat broths 
or jelly which has not been acted upon by the digestive juices. He 
has also found that these bacilli generate two poisons, one of which 
causes, when given to animals, salivation, paralysis, and diarrhoea, the 
other, violent and exhausting diarrhoea alone. Milk diet is, therefore, 
evidently better than broth diet in typhoid fever, and we once more 
are able to explain an empirical fact by a scientific discovery. An- 
other reason for using liquid instead of solid foods, beyond the diffi- 
culty of digestion, is the fact that the solids may irritate or perforate 
the ulcers in the small intestines. 

Alcohol may be used in all stages as a stimulant, as a giver of 
force to the system, and as an aid to digestion. A very large part of 
the profession believes that the mere presence of an abnormally high 
temperature contra-indicates the use of alcohol. Mere high tempera- 
ture does not do so, however, and it seems probable that many deaths 
have resulted from putting into practice such a belief. 

High temperature of a sthenic type, with a full, tense, bounding 
pulse, and all the signs of a disease attacking one in the full vigor 
of life, of course precludes its use ; but in the high temperature of 
advanced typhoid, with the marked asthenia often present in that 
stage, alcohol should be given constantly in large amount. Under 
these circumstances the tissues which the man can afford to lose are 
gone, and much of the vital portion of his system is greatly en- 
croached upon ; the alcohol yields force to the body, and is burnt up 



TYPHOID FEVER. 621 

in great part, keeping the flagging heart pumping the tides of blood 
through the lungs and systemic circulation, when otherwise the very 
cardiac depression would produce hypostatic congestion, if not more 
widespread circulatory engorgement. 

A no less useful and valuable result obtained by the use of alcohol 
in the early stages of exhaustive fevers is the part that it plays in aid- 
ing digestion. The writer has elsewhere defined the difference between 
the influence of alcohol in the artificial digestion of the test-tube and 
that occurring in the stomach. No one doubts that alcohol added to 
a small amount of gastric juice in the test-tube, retards or prevents its 
action ; but evidence is abundant to prove that ingestion of this drug 
produces by its stimulating aud irritant action a very decided increase 
in the quantity of gastric juice secreted over and above the amount 
normally present. Aside from experimental evidence, every-day 
experience has taught the gourmand that alcohol, in a fairly concen- 
trated form, enables him to digest an amount of food which under 
ordinary circumstances would remain unchanged in his stomach. 

The importance of aiding the flagging powers of the stomach is not 
generally recognized ; but if one remembers the fact that at one time 
during the course of a severe attack of typhoid, an occasion must come 
wheu a struggle between the few remaiuiug grains of strength and the 
disease results in death or in recovery, its importance becomes evi- 
dent. By the ingestion and digestion of more food early in the 
attack, a larger amount of vital force remains for use at a crisis, and 
the chances of a recovery, to say the least, are increased. Alcohol 
may, therefore, be used all through the ordinary exhausting fevers — 
for the purpose, in the first stage, of aiding digestion, and, in the later 
stages of supporting the system; but the physician ought not to use 
it as a routine measure in every case without a rational idea of why 
he does so. 

In those cases in which a temporary loss of heart power is due to 
haemorrhage or some sudden severe depression, alcohol is, above all 
others, the remedy to be employed, in a hot and concentrated form. 

That alcohol may be misused and cause great harm, is of course 
known to every practitioner of medicine. So long as it reduces the 
temperature and lowers the rate of the pulse, causes a moist skin and 
tongue, and quiets nervous twitchings, it does good, and only up to 
this point is it to be employed. If its administration is pushed after 
this, the tendency to adynamia becomes, under the over-use of the 
drug, one of dynamia ; the pulse is no longer soft, but comes in angry, 
bounding beats ; the nervous symptoms change from low, weak, mut- 
tering delirium, with subsultus tendinum, to wild, incoherent callings 
and strong tossings to and fro ; and by and by, when the influence of 
the alcohol begins to cease, and even before this time, the system has 
put forth the strength of days in a few hours, and the man, having no 
reserve strength, is dead. 

The treatment used by the author in his wards at the Jefferson 
Medical College Hospital and St. Agnes' Hospital give him results 



622 DISEASES. 

which the application of other methods have failed to give, and is as 
follows : 

As soon as the patient enters the house he is washed or bathed and 
placed in bed and required to remain there. He is assured that the 
more quietly he lies the more mild and safe will be the course of his 
attack, and is made to use a bed-pan and urinal and never allowed to 
get up. He is also given five drops of dilute hydrochloric acid in a 
wineglass of water every four hours, or if the bowels are not active, 
nitro-muriatic acid is substituted therefor, care being taken to employ 
one, two, or three drops of the strong, freshly mixed orange acid, accord- 
ing to the degree of coating of the tongue. The diet is strictly milk 
diet, namely, a quart to a quart and a half a day, with a little salt to 
flavor it, as already described in the article on Indigestion. In some 
cases koumyss acts very much better than milk. Sometimes, if vomit- 
ing is threatened, lime-water is added or the milk is peptonized or beef- 
tea is temporarily employed. In other instances the milk agrees with 
the patient if it is partly diluted with plain soda or Apollinaris water. 

For the dry and sordes-covered tongue, a mouth-wash of glycerin 
and water, half and half, to which may be added a little lemon-juice, 
is used. If constipation is very obstinate and continues over two days 
an injection is employed, and if this, after being used twice, fails to 
act, a dose of calomel ^ grain every fifteen minutes, till a grain has 
been taken, is prescribed, and if no movement occurs in twelve hours, 
is followed by half an ounce of sulphate of magnesium, or, best of all, 
a teaspoonful of liquorice powder is given. 

When diarrhoea becomes troublesome, over four or five passages a 
day, the following will be of service: 

R. — Acid, sulph. aromat f^ij- 

Extract, hsematoxyli fl. .... fgiij. 

Syr. zingiberis . . . . . . f.^iij. M. 

S. — Teaspoonful in water every hour until relieved. 

Just so soon as any evidences of tympanites or much meteorism 
come on, turpentine is given as follows : 

R — 01. terebinthinse . . . . . . f.^ij 

Syr. acacise. ... q. s. ad f* 3 iij . M. 

Ft. in emulsion. S. — Teaspoonful three times a day. 

At the same time it is well to employ a turpentine stupe over the 
abdomen (see Turpentine). Where the tympanites is excessive it may be 
relieved by an injection made up as follows : 

R. — 01. terebinthinse f gj to ij. 

01. olivse ........ f .^iv. 

Mist, asafoetidse 6j. M. 

S. — Use as an injection. Shake well before using. 

In the later stages of typhoid fever, as convalescence is approached, 
turpentine is invaluable, as it causes rapid healing of the intestinal 
ulcers and stops diarrhoea, preventing relapses through the absorption 
of poisonous materials from the unhealed intestinal lesions. 



TYPHOID FEVER. 623 

For many days after the patient begs hard for solid food it should 
not be allowed, for he will ask for it long before he should have it, 
but if the temperature remains normal for five days very soft boiled 
rice may be used in broth. 

Sometimes curds and whey make a pleasant change in the diet. 

The complications of typhoid fever of the most serious import are 
haemorrhage from the bowel, pneumonia and pleurisy, and perforation 
of the gut. 

The haemorrhage from the bowel may be stopped as indicated under 
that heading (Haemorrhage), and the pneumonia or pleurisy should 
be treated as are these diseases when free from complications ; but it 
is to be remembered that this is an asthenic or adynamic case which must 
not be bled or depressed, but stimulated. When perforation of the in- 
testine appears, large doses of morphine should be given to relieve 
pain, put aside collapse, and allay irritation. Warm applications 
should be used over the belly and down the limbs, and stimulants 
given, if needed. 

Probably, in the future, surgery will add another triumph to the 
art by devising some fairly safe plan of operative interference in this 
accident, which, if left alone, is almost always fatal. 

The method of cold bathing, introduced by Brand, has given such 
wonderful results in the treatment of this disease, and has been so 
thoroughly tried, both in this country and abroad, that its application 
should be well understood and practised whenever it is possible to do 
so. The method consists in immersing the patient every three hours 
in a bath at a temperature of 85° F., or as low as 75° F. if neces- 
sary, and allowing him to remain in the water until the temperature 
falls to 100.5° or 101° ; the bath being used with the frequency named 
as long as the temperature is above 102°. Before enteriDg the bath 
it is well to give the patient half to one ounce of whiskey in a little 
milk or water to prevent any depression from his being moved into 
the tub. The patient will generally complain bitterly of the cold, par- 
ticularly at first, and will also appear somewhat blue and chilly after 
the bath, but these signs are not to alarm the physician, unless there 
is prolonged and persistent coldness, when hot bottles should be applied 
to the feet, and in some cases a little whiskey or brandy administered. 
When the bath is given, cold should be applied to the vertex to pre- 
vent a congestion of the head, which, of course, is not under water. 
The patient should either be immersed or the directions given on page 
352, in regard to the use of the cold pack, be followed. The bath 
ought always to be near the bed, and a sufficient number of assistants 
should be present to lift the patient without his putting forth any exer- 
tion whatever, as this consumes his strength, which must be preserved 
with the greatest care. 

During the time the patient is in the bath the nurse should rub the 
surface of the body briskly in order to bring the blood to the surface, 
and prevent congestions in internal organs. In cases where the patient 
objects so strongly to the cold bath that the physician cannot resort to 
it, it is sometimes possible to have the objections removed by putting 



624 DISEASES. 

the patient in the water at 95°, and cooling the bath by the gradual 
addition of cold water to 75°. 

It is said that pneumonia, intestinal haemorrhage, menstruation, 
nephritis and cardiac complications are none of them contra-indications 
to this method of Brand, but the author would not resort to it if any 
of these conditions were actively present. 

One fact more should be stated, namely : That this method, while 
not wholly doing away with all other treatment, generally makes other 
measures unnecessary, although it is, of course, advisable to move the 
bowels every few days, if constipation be present, by injections, and 
to peptonize the milk if the digestion is faulty. 

The advantages gained by Brand's method are a mortality 150 per 
cent, less than any other known method, the absence of high fever, the 
avoidance of disagreeable complications of all kinds, and the produc- 
tion of a rapid convalescence. 



VITREOUS DISEASES. 

Vitreous opacities may be either dust-like, flaky, or dense and mem- 
branous. They impair vision in proportion to their number and den- 
sity, and are to be detected with the ophthalmoscope. Patients detect 
them as floating dark spots in their field of vision, because the opacities 
cast a shadow upon the retina. If vitreous disease is syphilitic, the 
usual remedies are indicated. Hypodermic injections of pilocarpine 
act favorably, and in the earlier stages of the inflammations of the 
retina, choroid, iris, and ciliary body upon which the opacities depend, 
leeches should be applied to the temple. Galvanism has been recom- 
mended. 

VOMITING. 

Vomiting is, of course, a symptom, not a disease, and arises from 
a large number of causes, some of which are very unimportant, others 
very serious. The most common cause is probably lack of proper 
digestion, with all that this implies — that is, gastro-intestinal irrita- 
tion and perversion of normal function. Additional causes are cere- 
bral haemorrhage, tubercular meningitis, cerebritis, or uraemia, which 
cause irritates the vomiting centre, or diseases of the middle lobe of 
the cerebellum, or vertigo, which is probably largely dependent upon 
disease of this lobe or the nerve-fibres going to it. 

These latter states may all be considered as lesions of a centric char- 
acter which directly or indirectly cause the vomiting centre to send out 
impulses. On the other hand, it is worthy of note that, under certain 
circumstances, vomiting may be reflex and dependent upon irritation 
of the nerves of the stomach or elsewhere, w r hich convey impulses to 
the muscles whose activity results in vomiting. These conditions are 
well represented by the vomiting which comes on in incarcerated 



VOMITING. 625 

hernia, or in pregnancy, or in that occurring during the passage of renal 
or hepatic calculi, or in indigestion. 

It is important to bear in mind that peripheral vomiting due to 
disorder of the gastric walls may be dependent upon two conditions. 
The mucous membrane and its nerves may be over-excitable, or they 
may be depressed. For this reason we shall find that two modes of 
treatment are necessary when this subject is considered below. 

The mechanism of vomiting consists in the closure of the pyloric 
sphincter, the contraction of the gastric muscles from the pylorus to 
the cardia, and at the same time, and more important than these 
movements, the contraction of the supplementary respiratory and 
abdominal muscles, which so compress the stomach as to drive out its 
contents through the open oesophagus. The violence of the muscular 
contractions in the abdominal walls is greatest when the stomach is 
partly empty, and gives rise to the pain and exhaustion accompanying 
the condition known as retching. The practical point to be learned 
from this is that vomiting is always easier when the stomach is full ; 
so, if an emetic is given on an empty stomach, as the popular expres- 
sion runs, a large amount of liquid should precede or accompany it, if 
possible. Dogs vomit easily because of the development of the gastric 
muscles, but they render the effort easier by filling the stomach with 
air, and so completely fill the viscus that its walls can contract on a 
resisting mass. 

Having described the mode and causes of vomiting, it still remains 
for us to consider its treatment. 

It is needless to remark that the vomiting of cerebral disease is 
very intractable, and that very active agents must be used to stop it. 
Probably the vomiting following etherization is centric, and should 
be treated, as should all forms of obstinate emesis, by the injection 
into the rectum of 40 grains of sodium or potassium bromide and 20 
drops of laudanum in 4 to 8 ounces of water. If this does not stop the 
vomiting a second injection may be given one hour after the first. 

When vomiting seems to be due to hyper-excitability of the gastric 
mucous membrane, so that very small amounts of food when swallowed 
are at once rejected, local anaesthetics and depressants are needed, the 
chief of these being cocaine and aconite. Both of these drugs, however, 
have disadvantages, because in effective dose their general physiological 
action may be very severe and almost poison the patient. When given 
to act as anti-emetics, these drugs do so by acting as local anaesthetics, 
or in other words by paralyzing the peripheral sensory nerves. Cocaine 
should be given in the- dose of 2 to 3 drops of a 4 per cent, watery 
solution, every fifteen minutes until 10 drops are taken. The aconite 
should be used in the form of the tincture, the patient being placed 
flat on the back, so as to withstand the ensuing cardiac depression 
with the least inconvenience, and 2 to 5 drops of the drug given in 
a little water every thirty minutes until the rapidly weakening pulse 
forbids its further use. This drug may be resorted to in all forms of 
vomiting due to irritability of the stomach, but it is contra-indicated 

40 



626 DISEASES. 

in cases of debility or weakness. Aconite is generally to be preferred 
to cocaine. 

Sometimes a prescription of the following character is of service, the 
bismuth acting as a coating to the walls of the stomach, protecting and 
soothing them : 

R. — Bismuthi subnitrat ^iij. 

Tr. aconiti . . . . gr. xx vel xxx. M. 

Ft. chart no. x. S. — One powder every half-hour. 

This prescription is very useful if the vomiting becomes excessive, 
and is due to acidity or fermentation. 

In other cases of the same type the following is useful, and is to 
be preferred if, owing to active fermentation, the vomiting is ex- 
cessive (the creasote or carbolic acid being a local anaesthetic and anti- 
septic) : 

R . — Acid, carbolic, vel creasoti (beechwood) gtt. x vel xx. 

Bismuthi subnitratis 5 iij . M. 

Ft. in chart no. x. S. — One powder every hour. 

Sometimes pure chloroform in 1 or 2-drop doses, in a little water, 
does good ; and dilute hydrocyanic acid, in the dose of 2 to 6 drops is 
also of value in like instances, given in a tablespoonful of water. 

The treatment of a case of vomiting dependent rather upon de- 
pression and debility of the stomach than upon irritation, is directed 
to the administration of gastric and it may be systemic stimulants. 
The chief one of the gastric stimulants is ipecac in small doses, and 
it is this employment of a drug generally resorted to for the produc- 
tion of ernesis by physicians, which has caused homoeopaths to claim 
that the regular school obey the law of similia similibus curantur and 
infinitesimal doses. The claim only holds good on its face, for we do 
not use an infinitesimal dose, and obey no law, but use common sense. 
Ipecac is an irritant, even to the skin, and it is partly by its irritant 
effects that it causes vomiting by exciting the stomach to a point over 
and above its normal condition. In the vomiting depending upon 
gastric debility and depression small doses of ipecac do good, because 
they irritate the stomach sufficiently to restore its normal tone without 
going to the other extreme of hyper-excitation. Under these circum- 
stances drop doses of the wine of ipecac, or ^ of a grain of the pow- 
dered ipecac, every hour, is of the greatest value, often succeeding after 
all remedies have failed. 

In other instances tincture of nux vomica, given in J to 1-drop 
doses, is useful as follows : 

R. — Tinct. nucis vomicae . . . . gtt. iv vel viij. 

Aquae cinnamomi . . . . . . f Jj. M. 

S. — Teaspoonful every half-hour or hour. 

In the nausea and vomiting following an alcoholic debauch J to 1 
drop of Fowler's solution every two hours, or before food, often gives 
relief, and it may be used in some cases in place of the nux vomica 
and ipecac. Another useful measure for the cure of alcoholic nausea 



WHOOPING-COUGH. 627 

is the use of full doses of hydrochloric acid, 5, 10, or 15 drops of 
the dilute acid in half a tumblerful of water, repeated every two 
hours. 

In all cases of persistent vomiting counter-irritation should be 
applied over the stomach in the form of a mustard plaster, or, if 
preferred, an ice-bag may be applied to the nape of the neck, the 
lumbar spine, or the epigastrium. 

The food given in cases of vomiting should be especially prepared. 
It is always best to use peptonized milk made by using the pepton- 
izing materials sold by all the large drug firms of reliability. (See 
article on Diet, page 372.) Lime-water should always be put in the 
milk if it is not peptonized ; the amount usually employed is perfectly 
useless because of its smallness — at least 2 or 3 tablespoonfuls should 
be placed in each glass of milk. 

Another point of importance is the quantity of liquid taken. As 
fast as the patient vomits he is often fed with glasses full of liquid 
by well-meaning friends. Iustead of this he should have only 1 
or 2 teaspoonfuls of milk every hour, half-hour, or fifteen minutes, 
for it is better for him to retain a drachm than to take a quart and 
vomit it. 

Where vomiting is absolutely persistent, enemata previously partly 
or entirely digested must be resorted to. 



WHOOPING-COUGH. 

The remedies recommended for this disease are almost as numerous 
as the members of the medical profession, and every one of them is 
worthless so far as a cure is concerned. Probably the very best drug 
of all in the majority of cases is antipyrine. Given in the dose of J 
to 3 grains every five hours according to the age of the child it will 
nearly always decrease the number of paroxysms, but not the severity 
of each individual attack. 

Where the child will submit to it there is little doubt that quinine 
in a very fine spray will be of service in many cases, and it is very 
useful, when so used, as a prophylactic in other children of the same 
family, who it is feared will be attacked by the same disease. The 
strength of the solution to be employed should be about 1 grain to 
the ounce of water. 

There is no doubt that carburetted hydrogen as inhaled at gas 
works is useful as a curative measure is cases of whooping-cough. 

A very useful remedy in some cases is belladonna in the form of 
the tincture, in the dose of \ drop twice a day to a child of one or 
two years. Where great vascular engorgement ensues upon a severe 
coughing spell, vascular sedatives are of service. That is, in those 
cases in which haemorrhages from the nose, ears, and mouth take 
place, veratrum viride or aconite may be used unless the disease has 
already so exhausted the child that stimulants are needed, and cardiac 
sedatives are contra-indicated by the degree of adynamia present. 



628 DISEASES. 

The reason for this lies in the following facts : The vascular tension 
consequent upon the obstruction of respiration causes a rise of blood 
pressure from asphyxia, and the hemorrhages or the conjunctival 
ecchymoses are due to rupture of the small bloodvessels under the 
increased strain. By lowering vascular tension we prevent so great 
a spasm of the bloodvessels and avoid vascular rupture or dis- 
tention. 

Where paroxysms come on so rapidly as really to interfere seriously 
with respiration, the child should take a whiff of chloroform poured 
over the parent's hand and so relax the spasm, while in other instances 
nitrite of amyl is equally serviceable and always more safe. Only 2 
to 3 drops of the nitrite of amyl should be used at a time, and this 
fact must be impressed upon the parents. 

Benzine has been found useful in certain cases of whooping-cough. 
It should be lightly sprinkled about the room or on the bed-clothing. 
In France it has been used internally in the dose of 10 to 15 drops 
for this affection. This is scarcely to be recommended. 

The vomiting following the cough may be overcome by using such 
minute amounts of milk as to enable nutrition to go on without at 
any time overloading the stomach, as, for example, a teaspoonful after 
each paroxysm of cough. 

WORMS. 

Intestinal parasites may be said to be represented by the Ascaris 
Lumbricoides, or round-worm; the Taenia Solium, Tsenia Media 
Canellata, and the Bothriocephalus Latus, or tape-worms ; and, finally, 
by the Oxyuris Vermicularis, sometimes called seat-, pin-, or thread- 
worms. 

The round-worm and tape-worm are to be attacked by way of the 
patient's mouth, the seat-worms by way of the anal opening ; but 
before mentioning the drugs to be employed it is necessary to insist 
upon one or two important points, disregard of which will result in 
failure in treatment. 

Whenever a round- or tape- worm is to be attacked, the patient must 
be starved for at least twelve to twenty-four hours, in order that no 
food in the intestinal tract may protect the worm from the action of 
the drug. During this time a little milk may be taken, and after a 
night of fasting, before breakfast, the anthelmintic must be swallowed. 
Further than this, nearly all of these drugs must be followed by purges 
in order to dislodge the intruder while he is paralyzed and has lost his 
hold ; and in many instances it is well to have a basin of salt and 
water ready so that when a passage occurs a rectal injection may be 
given to wash out any segments of the worm which remain behind 
in the rectum. 

In the treatment of thread-worms it is necessary to fill the bowel 
thoroughly with soap and water to dislodge the fsecal matter and ex- 
pose the worms in the folds of the mucous membrane. 

The drugs which are used against the round-worm are : Spigelia in 



worms. 629 

the form of the fluid extract, dose 1 drachm to a child of two or three 
years, or 2 drachms to an adult , or, better still, the fluid extract of 
spigelia and senna, dose 2 to 3 drachms, given in divided doses to a 
child. Oil of chenopodium, dose 5 to 20 drops on sugar. Santonin, 
dose J to J grain to a child in the form of troche, made by using the 
crystals, or as much as 2 to 4 grains to an adult. (See Santonin.) 

Brayera, or kooso, is given for the removal of the same worm in the 
form of an infusion, which is made by adding \ ounce of the powdered 
leaves to 1 pint of water and mucilage of acacia, one-half of each. 
This may be taken at one dose, or the fluid extract may be given in 
the dose of \ ounce to an adult. Koosin may be given in 40-grain 
doses in capsule to adults, but it should not be used against worms in 
pregnant women, as it may cause abortion. 

Unless the spigelia is used with senna it should always be followed 
after from two to four hours by a full dose of castor oil or a saline 
purgative to sweep out the worm, and the same rule applies to all the 
drugs mentioned above. 

The most efficient remedy against the tape-worm is pelletierine, the 
active principle of pomegranate, dose 1 to 2 grains in capsules ; or 
pepo, or pumpkin-seeds (2 ounces), may be resorted to when deprived 
of their outer coating and rubbed into a paste with sugar. Almost, 
if not quite, as valuable a remedy is male fern, or Filix mas, or, as it 
is officially called, Aspidium. Used in the form of the oleoresin (Oleo- 
resina Aspidii), in the dose of J to 1 drachm to an adult, it should be 
followed in three or four hours by a calomel purge, aided by a saline. 
Either the calomel or the increased amount of bile which is present is 
apparently peculiarly abhorrent to the tape-worm, and its free excretion 
should follow the use of all the drugs just named. 

By far the most useful remedy for seat-worms is quassia used by 
injection. One to two ounces of powdered quassia or quassia chips 
may be made into a decoction with a pint of water, and half of this 
injected into the rectum after it has been well cleansed with soap and 
water. The quassia injection should be held for some minutes, and in 
children this may be accomplished by pressing upon the anal opening 
the ball of the thumb covered by a pad formed from a small folded 
toAvel. If this treatment fails to bring away all the worms in three 
or four trials, either there are none present or the bowel is not thor- 
oughly invaded by the injection. In some cases the worms infest the 
colon, and forced injections are necessary. 



TABLE OF DOSES OF REMEDIES. 



Eemedies. 

Abstract, aconiti . 

aspidospermse . 

belladonna? . . 

cannab. ind. . . 



digitalis .... 
gelsemii .... 
hyoscyami . . . 
ignatiae .... 

ipecac 

jalapa? 6 

nucis vom J 



Phytolacca?. 
pilocarpi . 
podophylli 



Valeriana? . . 

veratr. vir. . 
Acetanilide . . 
Acetone . . . 
Acetpb enetidine 
Acet. lobelise 

opii .... 

sanguinar. 

scillse . . . 
Acid. acet. dil. . 



arsenious 

benzoic 

boric 

carbolic 

gallic 

gall, in albuminuria . . 
hydrobrom. (34 per cent.) 
bydrobrom. dil. . . . 

bydrochlor 

bydrocblor. dil. . . . 
bydrocyan. dil. . . . 

lactic 

nitric 

nitric dil 

nitro-hydrochlor. . . . 
nitro-bydrocblor. dil. 
phosphoric (50 per cent.) 



5 
6 
1 
4 
10 
1 
1 
5 
2 

15 
5 
15 
10 
60 

5 

5 

1 

3 

10 

10 



Dose. 

to \ 

20 

n 

3 
2 
3 
2 
5 
3 
30 
10 

15 
30 

5 
10 
15 

2 



20 



g- 
g- 
g- 
g- 
g- 
g- 
g- 
g- 
g- 
m. 

g- 
m. 



30 
16 m. 
30 m. 
30 m. 

90 m. 

its g- 
15 g. 
10 g. 

3 g- 
15 g. 
60 
15 



g- 



40 m. to 2 fl. d. 



to 10 m. 
m. 
m. 



30 
6 

60 g. 
10 m. 
30 m. 
10 m. 
20 m. 
15 g. 



Eemedies. 
Acid, phosphoric dil. . .10 

salicylic 5 

sulphuric 2 

sulphuric dil 5 

sulphuric arom. ... 5 

sulphurous 30 

tannic 2 

Aconitina (white crystals) . ? -J-q- 

Adonidin £ 

Agaricin 1 

Aloe 2 

Aloinum £ 

Alumen 10 

Ammonii benzoas . . .10 

bromid 5 

carbon 3 

chlorid 10 

iodid 3 

phosph 1 

picras % 

sulph 3 

valer 3 

Amyl nitris 2 

Amylum iodatum ... 3 

Antimonii et pot.tart.; diaph. -£$ 

et pot. tartr. ; emetic. . 1 

oxid H 

oxysulphuret £ 

sulphid i 

sulphuret £ 

Antipyrine 2 

Apiol 3 

Apomorph. bydrochlor. . ^ 
Aqua ammonise .... 6 

amygd. amar 1 

camphorse \ 

chlori 1 

creasoti 1 

lauro-cerasi 6 

Arbutin 5 

Argenti iodidum . . . . \ 

nitras \ 

oxid \ 



Dose. 




to 30 


m. 


" 20 


g- 


" 5 


m. 


" 30 


m. 


" 30 


m. 


" 60 


m. 


" 10 


g- 


" 2ihr 


g- 


" \ 


g- 


" 4 


g- 


" 5 


g- 


" 2 


g- 


" 15 


g- 


" 20 


g- 


" 30 


g- 


" 10 


g- 


" 30 


g- 


" 15 


g- 


" 5 


g* 


" i 


g- 


« 15 


g- 


" 15 


g- 


" 5 


m. 


" 30 


g- 


U 1 


g- 


" 2 


g- 


" 2 


g- 


" 2 


g- 


" 2 


g- 


" 2 


g- 


" 20 


g- 


" 5 


g- 


"A 


g- 


" 30 


m. 


« 2 


fl.d. 


" 2 


fl. oz 


" 4 fl. d. 


« 4 


fl.d. 


" 30 


m. 


" 15 


g- 


" 1 


g- 


" J 


g- 


" 2 


g- 



632 



TABLE OF DOSES. 



Remedies. 
Arsenii iodidura . . . . 

Asafoetida 

Atropina 

Atropines sulph 

Auri et sodii chlorid. . . 
Balsamum gurjunae . . . 
Belladonnas fol 

rad 

Benzanilide 

Berberi na 

Berberinas sulph 

Bismuthi citras . . . . 

et amnion, eitr 

salicylate 

subcarb 

subnitr 

tannas 

valer 

Brayera 

Brucina 

Caffeina 

Caffeinse citras 

Calcii bromidum . . . . 

carb 

bypopbosphis . . . . 

iodidum 

Calcii pbospbas . . . . 
Calx chlorid urn .... 

sulphurata 

Campbora 

monobromata . . . . 

Cantbaris 

Capsicum 

Castaneum 

Castoreum 

Catechu 

Caulophyllin 

Cerii nitras 

oxalas 

Chinoidinum 

Chinoline 

Chloral . 

Chloroformum 

Chrysarobinum . . . . 

Cinchona 

Cinchonidina, and its salts 
Cinchonina, and its salts . 

Cinnamomum 

Cocaine 

Cocas fol 

Codeina 

Colchicin 

Colocynthin 

Confectio sennae .... 



Dose. 

fa t0 fa g 

5 " 20 g 

i¥s " fa 

ih " fa g 

fa " fa g 

" 30 m 

« 10 g 

" 5 g 

" 6 g 

" 10 g 

" 10 g 

" 15 g 

" 15 g 

« 15 g 

" 30 g 

« 60 g. 

" 30 g 
" 3 



£ 
1 
5 
6 

15 
i 
1 
1 
3 
5 
3 
1 
3 

15 
1 
1 
6 
1 
1 
i 

1 



g 

" 6 d 

" fa g 

" 5 g 

" 5 g 

« 30 g 

" 60 g 

" 15 g 

" 3 g 

« 30 g 

" 5 g 

« 1 g 

" 10 g 

" 5 g 

« 2 g 

" 3 g 

" 10 g 

" 15 g 

« 30 g 

" * g 

" 3 g 

« 3 g 

" 30 g 

" 10 g 

" 20 g 

" 5 m 

" 15 g 

" 60 g. 

" 30 g. 

« 30 g 

" 30 g 

" 2 

" 3 

" 2 

"3V 

" 1 

" 2 



Remedies. Dose. 

Coniina, and its salts . . -fa to ^ 2 

Convallamarin . . . . £ " 2 

Copaiba 15 " 60 

Cota 1 " 2 

Cotoina £ " i 

Creasoturu 1 " 3 

Creta praepar 15 "75 

Croton chloral 1 " 5 

Cubeba 15 " 60 

Cupri acetas k " £ 

sulphas i " i 

Curare fa " & 

Curarina fe " ^ 

Daturine tU" fa 

Decoct, aloes comp. . . . \ " 2 

sarsap. comp 2 " 6 

Digitalinum ^L " -fa 

Digitalis folia £ *" 2 

Duboisina, and its salts . T -J-g- " -^ 

Elaterinum ; U. S. P., 1880 ^ " T ^ 

Elaterinum; U. S. P., 1.870 T V " £ 

Emetina, and salts; emetic J " £ 

dia P h ik " ^ 

Emulsio hydrocyan. . . . £ " 1 

Ergota 15 " 60 

Ergotinum 2 " 8 

Eserina, and its salts . • fa " fa 

Extr. aconiti fol. fluid. . . 1 " 5 

aconiti rad.; U.S. P., 1880 & " i 

aconiti rad. fluid. . . . J " 2J 

aconiti fol. (B. P.). . . J " i 

aconiti fob; U.S. P., 1870 J " i 

aletridisfl 15 "30 

alni rubrae fi 15 " 30 

aloes aqueos % <e 3 

alston. constr. fl. . . . 1 " 2 

angelicse rad. fl. ... 30 " 60 

angusturas fl 1 5 " 45 

anthemidis 2 "10 

anthemidis fl 30 "60 

apocyni andros fl. . . . 5 "30 

apocyni cannab. fl. . . 8 " 30 

araliae bisp. fl 30 "50 

aralias nudic. fl. ... 30 " 60 

araliae racem. fl. ... 30 " 60 

araliae spin, fl 30 "60 

arecae fl 45 " 75 

ari triphylli fl 15 "30 

arnicas flor 3 " 8 

arnicse fl 5 " 15 

arnicae rad 2 " 5 

arnicas rad. fl 5 " 15 

asari fl 15 " 30 

asclep. incar. fl. ... 15 " 30 



g- 

g- 

g- 
fl.oz. 
fl.oz. 

g- 
g- 
g- 



g« 
g- 
g- 

m. 

g- 
m. 

g- 

g- 

g- 

m. 

g- 
fl.d. 
m. 
m. 

g- 

m. 
m. 
m. 
m. 
m. 
m. 
m. 
m. 
m. 

g- 
m. 

g- 

m. 
m. 
m. 



TABLE OF DOSES. 



633 



Remedies. Dose. 

Extr. asclep. syr. fl. . . .15 to 30 m. 
asclep. tuber, fl. . . .15 " 30 m. 

aspidii fl 1 " 2 fl. d. 

aspidospermse fl. . . .15 " 45 m. 

auranti cort. fl i " 2£ fl. d. 

azedarach fl 15 " 75 m. 

baptisiaefl 7 " 30 m. 

bellad. alcoholic. . . . £ " 4 g. 
bellad. fol. (B. P.) . . . £ « § g. 

bellad. fol. fl 3 " 6 m. 

bellad. rad i " i . g- 

bellad. rad. fl 1 

berber. aquifol. fl. . . .15 

berber. vulg. fl 15 

boldi fl 3 

brayerae fl 2 

bryoniae fl 15 

buchu fl 4 

calami fl 15 

calend. fl 15 

calumbae 3 

calumbae fl 15 

canellae fl 15 

cannab. Amer. fl. . . . 3 

cannab. ind £ 

cannab. ind. fl 3 

capsici fl 1 

cardam. comp. fl. . . .15 

carnis 15 

cascarae sagradee fl. . .10 

cascarillse fl J 

castanae fl f 

catariae ...'... i 

catechu liquid 8 

caulophylli fl 15 

chelidonii fl 15 

chelonisfl 30 

chimaph. fl I 

chionanthi fl f 

chirettse fl 4 

cimicifugae fl 8 

cinchonse 15 

cinchonas fl 30 

cinchonse arom. fl. . .30 
cinchonee comp. fl. . . 4 
cocae 1 



cocculi fl 1 

colch. rad J 

colch. rad. fl. . . 
colch. sem. fl. . . 
collinsoniae fl. . . 
colocynth. . . . 
colocynth. comp. . 



condurango fl 8 



" 3 m. 
" 30 m. 
" 30 m. 
" 15 m. 
" 4 fl. d. 
" 60 m. 
" 24 fl.d. 
" 60 m. 
" 60 m. 
« 10 g. 
" 60 m. 
" 60 m. 
" 15 m. 

" 1 g- 

" 6 m. 

" 3 m. 

" 45 m. 

« 60 g. 

" 20 m. 

" 24 fl. d. 

" 24 fl. d. 

" 1 fl.d. 

" 30 m. 

" 30 m. 

" 30 m. 

" 60 m. 

" li fl. d. 

" 1 fl.d. 

" 1| fl.d. 

" 30 m. 

« 30 g. 

" 60 m. 

" 60 m. 

" li fl.d. 

" 2 d. 

" 3 m. 

" i g- 

" 4 m. 

" 6 m. 

" 60 m. 

" 5 g. 

« 5 g. 

" 30 m. 



Remedies. Dose. 

Extr. conii fol. (B. P.) . . 1 to 2 g. 

coniifol.alc.;U.S.P v 1870 1 " i g. 

conii fr. ale; U.S.P., 1880 J « 1 g. 

conii fol. fl 1 " 2 m. 

conii fr. fl. j U.S.P., 1880 li " 3 m. 

convallaria? rad. fl. . .15 " 30 m. 

coptidis fl 30 "60 m. 

corn. flor. fl 30 " 60 m. 

corydalis fl 15 " 30 m. 

coto fl 3 "15 m. 

cubebaa fl 15 " 30 m. 

cypripedii fl 15 " 60 m. 

damianee fl J " 2£ fl. d. 

delphinii fl 1 " 3 m. 

digitalis h " i g. 

digitalis fl. . . • . . 1 " 6 m. 

dioscorese fl 15 " 30 m. 

ditse fl 1 " 4 m. 

dracontii fl 30 " 60 m. 

droseree fl 5 " 10 m. 

dulcamara? 5 " 15 g. 

dulcamarse fl . . . . 1 " 2 fl. d. 

ergotse 1J " 8 g. 

ergotae fl. 15 " 60 m. 

eriodictyi fl 15 " 30 m. 

erythroxyli fl £ " 2 fl. d. 

ethoxycaffeine . . ' . . 2 " 4 g. 

eucalypti fl 15 " 60 m. 

euonymi fl 15 " 60 m, 

eupatorii fl. . . . ■ .30 " 60 m. 

euphorb. piluliferse fl. . 5 " 30 m. 

ferri pom 3 " 15 g. 

frangulse fl £ " 24 fl. d. 

frankeniae fl 8 " 15 m. 

gallae fl f . " 2 fl. d. 

gelsemii \ " 1 g. 

gelsemii fl 5 " 10 m. 

gent, fl 30 " 60 m. 

gent. comp. fl 30 "60 m. 

geranii fl 15 " 30 m. 

gei fl 15 "30 m. 

gilleniae fl 15 " 30 m. 

gossypii fl 15 " 45 m. 

granati rad. cort. fl. . . f " 2 fl. d. 

grind, rob. fl 30 " 60 m. 

grind, squarr. fl. . . . 30 " 60 m. 

guaiaci ligni fl 30 "60 m. 

guaranae fl 15 " 30 m. 

haematoxyli 8 " 30 g. 

haematoxyli fl 30 "60 m. 

hamamelid. fl 30 "90 m. 

helleb. nigris . . . . \ " 1 g. 

helleb. nigris fl. ... 5 " 15 m. 

heloniae fl 8 " 30 m. 



634 



TABLE OF DOSES. 



Remedies. Dose. 

Extr. hepaticae ft 30 to 60 m. 

humuli 3 " 15 g. 

humuli fl 30 " 60 m. 

hydrangea? fl 30 " 60 m. 

hydrastis : 3 " 10 g. 

hydrastis fl 8 " 30 m. 

hyoscyami (B. P.J . . . 1 " 4 g. 

hyoscyami ale 1 " 2 g. 

hyoscyami fol. fl. . . . 3 " 15 m. 

hyoscyami sem. fl. . . 2 " 8 m. 

ignatiae i " i g> 

ignatiae fl 1 " 6 m. 

ipecac, fl 3 " 60 m. 

iridis versicol 3 " 6 g. 

iridis versicol. fl. . . .15 " 30 m. 

jaborandi fl 10 " 60 m. 

jalapae; U. S.P., 1870 . 5 "10 g. 

jalapae ale 3 " 6 g. 

jalapae fl 15 " 30 m. 

juglandis 15 " 30 g. 

juglandis fl | " 2 fl. d. 

junip. fl 30 " 60 m. 

kamalaefl 30 " 60 m. 

kino, liquid 15 " 30 m. 

krameriae 5 " 15 g. 

krameriae fl 30 " 60 m. 

lactucae 5 " 15 g. 

lactucae fl 15 "60 m, 

lactucarii fl 8 " 30 m. 

lappae fl \ " 1 fl. d. 

laricis fl \ " 2 fl. d. 

leonuri fl 30 " 60 m. 

leptandrae 3 " 10 g. 

leptandras fl 30 " 60 m. 

lobeliae fl 1 " 5 m. 

lupuli fl 5 "15 m. 

lycopi fl 5 " 30 m. 

malti 1 " 2£ d. 

manzanitae fl £ " 2 fl. d. 

marrubii fl 1 " 2 fl. d. 

matico fl 30 " 60 m. 

matricariae 8 " 30 m. 

menispermi fl 30 "60 m. 

methysticae fl 15 " 60 m. 

mezerei £ " 1 g. 

mezerei fl. ...... 3 " 10 m. 

micromeriae 15 " 60 m. 

mitchellae fl 30 " 60 m. 

myricae fl 30 " 60 m. 

nectandrae 1 " 4 fl. d. 

nucis vom \ " i g. 

nucis vom. fl 1 " 5 m. 

nuphar fl 5 " 15 m. 

nymphaese fl 5 " 10 m. 



Remedies. 

Extr. opii £ 

papaveris \ 

papaveris fl 15 

pareirae fl 30 

petroselina fl 1 

phelandrii fl 1 

phoradendri fl £ 

physostigmatis . . . . T ^ 
physostigmatis fl. . . . 1 
phytolaccae baccar. fl. .5 
phytolaccae rad. ... 1 
phytolaccae rad. fl. . . . 5 

pilocarpi fl 15 

pimentae fl 15 

piper nig. fl 15 

piscidiae 1 

piscidiae fl 15 

podophylli \ 

podophylli fl 8 

polygoni fl 15 

polygonati fl 5 

populi fl 30 

prinos fl 30 

prun. virg. fl 30 

pteleae trifoliata . . .15 

pulsatillae fl 2 

quassiae 1 

quassiae fl 30 

quebracho fl 20 

quercus fl 30 

rhamni cath. ft. fl. . . 30 
rhamni pur. cort. fl. . .30 

rhei 5 

rhei fl 15 

rhois arom. fl 15 

rhois glabr. cort. fl. . .30 
rhois glabr. fruct. fl. . .30 
rhois toxicod. fl. ... 1 

ricini fol. fl £ 

rosae fl h 

rubi fl 15 

rumicis fl 30 

rutae fl 15 

sabbatiae fl 30 

sabinae fl 5 

salicis fl i 

salviae fl i 

sambuci fl £ 

sanguin. fl 5 

santali citr £ 

santonicae fl 15 

sarsap. fl i 

sarsap. comp. fl. . . . £ 
sassafras fl £ 



Dose. 




to £ 


g- 


" 2 


g- 


" 45 


m. 


" 60 


m. 


" 2 fl. d. 


" 2 


fl.d. 


" 1 


fl.d. 


« J- 


g- 


" 3 


m. 


" 30 


m. 


" 3 


g- 


" 30 


m. 


" 60 


m. 


" 45 


m. 


" 45 


m. 


" 2 


g- 


" 60 


m. 


" H 


g- 


" 30 


m. 


" 30 


m. 


" 15 


m. 


" 60 


m. 


" 60 


m. 


" 60 


m. 


" 30 


m. 


" 5 


m. 


" 5 


g- 


" 60 


m. 


" 60 


m. 


" 60 


m. 


" 60 


m. 


"120 


m. 


" 10 


g- 


"45 


m. 


" 60 


m. 


" 60 


m. 


" 60 


m. 


" 6 


m. 


" 1 


fl.d. 


" 2 fl.d. 


" 60 


m. 


" 60 


m. 


" 30 


m. 


" 60 


m. 


" 15 


m. 


" 2 


fl.d. 


" 2 


fl.d. 


" 2 fl. d. 


" 15 


m. 


" 1 


fl.d. 


" 60 


m. 


" 2 


fl.d. 


" 2 fl.d. 


" 2 


fl.d. 



TABLE OF DOSES. 



635 



Eemedies. Dose. 

Extr. scillae fl 5 to 30 m. 

scillae comp. fl 5 " 30 m. 

scoparii fl £ " 1 fl. d. 

Scutellariae fl £ « 2 fl. d. 

senecionis fl 1 " 2 fl. d. 

senegse fl 8 " 15 m. 

sennsefl 1 " 4 fl.d. 

serpent, fl 30 " 60 m. 

simarubae fl 15 "30 in. 

solidag. fl 30 " 60 m. 

spigelise fl 15 " 60 m. 

spigelian et sennae fl. . . £ " 2 fl. d. 

stillingiae fl £ " 2 fl. d. 

stillingiae comp. fl. . . £ " 2 fl. d. 

stramonii (B. P.) . . . £ " 1 g. 

stramonii fol. ale. . . . £ " § g. 

stramonii fl 1 " 6 m. 

stramonii sem £ " £ g. 

sumbulfl 15 " 60 m. 

taraxaci 5 " 15 g. 

taraxacifl £ " 2 fl.d'. 

thujae fl 8 " 15 m. 

toxicodendri fl 1 " 5 m. 

trifol. prat, fl f " 2 fl. d. 

trillii fl £ " 2 fl. d 

trit. rep. fl 1 " 4 fl.d. 

tussilag. fl 30 " 60 m. 

urticae rad. fl 5 " 15 m. 

ustilag. mayd. fl. . . .15 " 60 m. 

uvae ursi fl 30 " 60 m. 

vaccin. crassifol. fl. . .30 " 60 m. 

valerian 5 " 15 g. 

valer. fl 30 " 60 in. 

veratr. vir. fl 2 " 8 m. 

verbenae 15 " 60 m. 

viburni opuli fl. . . . 1 " 2 fl. d. 

viburni [prunifol.] fl. . 1 " 2 fl. d. 

wahoo 1 " 5 

xanthoxyli cort. fl. . .15 " 30 m. 

xanthoxyli fruet. fl. . .15 " 30 m. 

zingiberis fl 8 " 30 m. 

Fel bovis purif. .... 3 " 6 

Ferri arsen ?V " ^V 

benzoas 1 " 5 g. 

bromid 1 " 5 

carb. sacch 4 " 15 

cblorid 1 " 3 

citras 5 " 10 g. 

et ammon. citr 5 " 10 g. 

et ammon. sulph. ... 5 " 10 g. 

et ammon. tartr. . . . 5 "15 g. 

et cincbonid. citr. ... 5 " 10 

et pot. tartr 15 " 60 

et quin. citr 5 " 10 g. 



Remedies. 
Ferri et strychn. citr. . . 1 
hypophospbis .... 5 

iodidum 1 

iodidum sacch 2 

lactas 1 

oxalas 1 

oxid. magnet 5 

oxid. bydrat £ 

pbospbas 1 

pyropbospbas .... 1 

subcarb 5 

subsulpbas 1 

sulphas 1 

sulphas exsiccat. ... £ 

valer 1 

Ferrum dialys 1 

redact 1 

Fowler's solution .... 1 

Gamboge 1 

Gaultheria, oil of . . . . 2 

Gold bromide £ 

chloride of, and sodium . ^ 

Guarana 8 

Helleborein y 1 ^ 

Hydrarg. chlor. corros. . . ¥ ^ 

chlor. mite £ 

cyanidum -^ 

c. creta 3 

formamidatum (1 % sol.) 5 

iodid. flav £ 

iodid. rubr ■£$ 

iodid. vir £ 

oxidum flavum . . . ^ 

salicylatis £ 

subsulphas flav. . . . I 

tannas £ 

Hydrastin 5 

Hydrobromic acid (dilute) 1 

Hydroquinone 10 

Hyoscine T J^ 

Hyoscy amine, and its salts ± ^ 

Hypnone 5 

Ichthyol 3 

Infusum brayerae .... 2 

caulophylli 1 

digitalis 2 

sennae comp 1 

Iodoformum 1 

Iodol £ 

Iodum jJjj 

Ipecacuanha | * ' 

I emet. . . 15 

Jalapa 15 

Kairin 2 



Dose. 




to 3 


»• 


" 10 


g- 


" 5 


g- 


" 3 


g- 


" 3 


g- 


" 3 


g- 


" 10 


g- 


" 2 


oz. 


" 5 


g- 


" 5 


g- 


" 30 


g- 


a g 


g- 


" 3 


g- 


" n 


g- 


" 3 


g- 


" 15 


m. 


" 5 


g- 


" 5 


m. 


« 4 


g- 


" 10 


m. 


" £ 


g- 


" 2V 


g- 


" 30 


g- 


4 


g- 


"lV 


g- 


" 8 


g- 


" i 


g- 


" 8 


g- 


« 15 


m. 


" 1 


g- 


"■A 


g- 


" 1 


g- 


t( i 

4 


g- 


" 1 


g- 


" i 


g- 


" l 


g- 


" 10 


g- 


" 4 


d. 


" 15 


g- 


"tV 


g- 


"A 


g- 


" 20 


m. 


" 4 


g- 


" 8 


fl.oz 


" 2 


oz. 


" 4 fl.d. 


" 2 fl.oz 


" 3 


g- 


" 1 


e- 


4 


g- 


" 1 


g- 


" 30 


g- 


" 30 


g- 


" 8 


g. 



636 



TABLE OF DOSES 



Remedies. 

Kamala 1 

Kino 8 

Lactucarium 8 

Leontin i 

Lewinin 50 

Liq. ammon. acet. ... 2 

acidi arseniosi .... 2 

arsen. et hydr 2 

ferri chloridi .... 2 

ferri dialys 1 

ferri nitrat 8 

pepsini 2 

Liquor potassae .... 5 

potassii arsenit. ... 3 

potassii citrat 2 

sodas 5 

sodii arseniatis .... 3 

Lithii benzoas 2 

bromid 1 

carbonas 2 

citras 2 

salicylas 2 

Lupulinum 5 

Magnesia 15 

Magnesii earb 15 

citr. gran 2 

sulphas 2 

sulphis 8 

Manganese binox. ... 2 

Mangani sulphas .... 2 

Manna 1 

Massa copaiba? 5 

ferri carb 5 

hydrarg 1 

Mist, ammoniaci .... 4 

asafostidas 4 

chloroformi 1 

cretas 1 

ferri comp i 

ferri et amm. acet. . . ' 

glycyrrh. comp. ... 1 

magnes. et asafoet. . . 1 

potassii citr ^ 

rhei et sodas i 

Morphina, and its salts . . -fa 

Morrhuol 1 

Moschus 2 

Naphthalinum .... 2 

Naphthol 2 

Narceina & 

Nitroglycerinum . . . . 1 

Nux vomica 1 

Oleoresina aspidii ... 15 

capsici £ 



Dope. 




to 2 


d. 


" 30 


g- 


" 15 


g- 


" i 


g- 


% sol. 


" 8 fl.d. 


u 7 


m. 


« 7 


m. 


" 10 


m. 


" 15 


m. 


" 15 


m. 


" 4 


fl.d. 


" 30 


m. 


" 7 


m. 


" 4 fl.d. 


" 30 


m. 


u 7 


m. 


" 5 


g- 


" 3 


g- 


" 6 


g- 


" 5 


g- 


" 8 


g- 


" 10 


g- 


" 60 


g. 


" 60 


g- 


" 8 


d. 


" 8 


d. 


" 30 


g- 


" 4 


g- 


" 10 


g- 


« 2 


oz. 


" 30 


g- 


" 15 


g- 


" 15 


g- 


" 8 


fl.d. 


" 8 


fl.d. 


" 2 fl. d. 


" 2 fl. oz 


" 2 


fl.oz. 


" 1 


fl.oz. 


" 4 fl.d. 


" 4 fl.d. 


" 2 


fl.oz 


" 1 


fl.oz 


" h 


g- 


" 5 


g- 


'• 15 


g- 


" 10 


g- 


" 10 


g- 


" i 


g- 


m.ofl 


1c sol. 


" 5 


g- 


" 60 


g- 


" i 


g- 



Remedies. 
Oleoresina cubebse ... 5 

filicis 30 

lupulini 2 

piperis 1 

zingiberis 1 

Oleum copaibas . . . .8 

cubebse 15 

5 
5 
1 
1 
1 
5 
I 
I 

10 

1 

1 

20 

1 



engeron 

eucalypti 

gaultherise .... 

phosphoratum . . . 

sabinas 

terebinth 

tiglii 

Opium (14 % morphine) 

Pancreatin 

Papayotin 

Paracotin 

Paraldehyde .... 
Pearson's solution . . 
Pelletierine 2 



Dose. 
to 20 m. 
" 60 m. 
" 5 g. 
" 3 g. 
« 3 g. 
" 15 m. 
" 30 
" 15 
" 10 
" 20 
" 3 
" 3 
" 30 



11 fr 



g- 

Pepsinum purum. . . . 15 g. to \ oz. 

saccharatum 30 g. " 1 oz. 

Phenacetine 2 to 6 g. 

Phosphoric acid . . . . £ " 1 d. 

Phosphorus T k " sV g- 

Physostigminas salic. . . T J^ " -£% g. 

sulphas xhs " -h & 

Picrotoxinum ^ " & g. 

Pilocarpine, and its salts . ^\ " i g. 

Pil. aloes 1 

aloes et asafoet 2 

aloes et ferri 1 



aloes et mast 1 

aloes et myrrh as ... 2 

antim. comp 1 

asafoetidas 1 

cathart. comp. .... 1 

ferri comp 2 

ferri iodidi 1 

galbani comp 1 

opii 1 

phosphori 1 

rhei 2 

rhei comp 2 

Piperinum 1 

Plumbi acetas J 

iodidum J 

Potassii acetas 15 



bicarb. . 
bitartr. , 
bromid. 
carb. 
chloras , 



3 pills. 
5 pills. 
3 pills. 
3 pills. 

5 pills. 

3 pills. 

6 pills. 

4 pills. 

5 pills. 
4 pills. 

6 pills. 

2 pills. 

4 pills. 

5 pills. 
5 pills. 
8 g. 

3 g- 
3 g- 

g. 

g- 
g- 
g- 
g- 
g- 



TABLE OF DOSES. 



637 



Remedies. 

Potassii eitras 15 

cyanid T V 

et sodii tartr £ 

hypophosphis .... 5 

iodid 2 

nitras 8 

sulphas 1 

sulphidum 1 



sulphis 15 



tartras .... 
Pulv. antimonialis 
aromat. . . . 
cretae comp. . . 
glycyrrh. comp. 
ipecac, comp. 
jalapae comp. 
morphinae comp. 
rhei comp. . . 



Pyridine ....... 1 

1 
1 
1 

2 



Pyrodine 

Quinidina, and its salts . 
Quinina, and its salts . 
Quininae arsenias . . . 
Eesina copaibae . . . 



guiaici 10 



podophylli £ 

scammonii 2 

Resorcin 2 

Rheum 2 

Saccharin £ 

Salicinum 8 

Salicylate of bismuth . . 3 

of mercury -^ 

of sodium 5 

Salol 10 

Santonica 8 

Santoninum 1 

Sapo 5 

Scammonium 3 

Senna 8 

Sodii acetas 15 

arsenias -^ 

benzoas 5 

bicarb 8 

bisulphis 8 

boras 8 

bromid 8 

carb 8 

carb. exsicc 5 

chloras 5 

hypophosphis .... 8 

hyposulphis 8 

iodidum 5 



60 

5 

30 

15 

60 
60 

tV 

15 
30 
30 

30 
30 

30 
15 
30 
15 

30 

15 



Dose. 

to 60 g. 

£ g. 

1 oz 

15 g. 

' 30 g. 

' 15 g- 

' 4 d. 

< 10 g. 
' 30 g. 

< 8 d. 
' 3 g. 

< 30 g. 
' 30 e. 



15 

60 

10 

60 

5 

3 

30 

30 

1 

10 

20 

5 

i 

5 

4 

30 

4 

30 

15 

of i 
to 60 
" 15 



g- 



Remedies. 
Sodii phosphas .... 2 

salicylas 5 

santoninas 2 

sulphas 1 

sulphis 8 

Sparteine sulph \ 

Spiritus aetheris compositus 30 
aether, nitrosi . . . . \ 

ammoniae 8 

ammoniae arom. ... 15 

camphorae 8 

chloroform i 15 

lavand. comp. .... 30 

menth. pip 30 

Strontium bromidi ... 20 

lactati 20 

iodidi .10 

phosphat 20 

Strophanthin -^ 

Strychnine, and its salts . ^ 

Sulphur £ 

Syr. calcii lactophos. . . 1 

calcis 15 

ferri bromidi ... .15 

ferri iodidi 15 

ferri oxidi — 

ferri hypophosph. ... — 
ferri quin. et strych. phos. — 

hypophosphit — 

hypophosph. c. fer. . . — 

ipecac -. \ 

krameriae \ 

lactucarii 1 

rhei 1 

rhei arom 1 

rosae 1 

sarsap. comp 1 

scillse \ 

scillse comp 15 

senegae 1 

sennae 1 

Terebene ... ... 5 

Terpine hydrate .... 10 

Terpinol 2 

Thallin 1 

Theine 1 

Thymol 1 

Tinct. aconiti fol 8 

aconiti rad 1 

aconiti rad. (Fleming's) . § 

aloes (1880) £ 

aloes et myrrhae ... 1 

arnicas flor 8 

arnicae rad 15 



Dose. 


to 15 g. 


" 30 g. 


" io g. 


" 2 g. 


" 30 g. 


« 4 g. 


" 60 m. 


" 2 fl. d. 


" 30 m. 


" 60 m. 


" 30 m. 


" 60 m. 


" 60 m. 


" 60 m. 


" 30 g. 


" 30 g. 


" 20 g. 


« 30 g. 


" ih m - 


"A g- 


" 4 d. 


" 2 fl. d. 


" 30 in. 


" 60 m. 


" 40 m. 


" 1 fl.d. 


" 1 fl. d. 


" 1 fl. d. 


" 1 fl. d. 


" 1 fl. d. 


" 1 fl. d. 


" 4 fl. d. 


" 3 fl.d. 


" 4 fl. d. 


" 4 fl. d. 


" 2 fl. d. 


" 4 fl. d. 


" 1 fl.d. 


" 60 m. 


" 2 fl. d. 


" 4 fl. d. 


" 10 m. 


" 20 g. 


" 10 m. 


" 3 g. 


" 2 g. 


to 5 g. 


" 16 m. 


" 5 m. 


« 2J m. 


" 2 fl.d. 


" 2 fl.d. 


" 30 m. 


" 30 m. 



638 



TABLE OF DOSES. 



Remedies. Dose. 

Tinct. asafoetidae . . . . 30 to 60 m. 

belladonnas 8 " 15 m. 

bryoniae 15 " 30 m. 

calendulas 16 " 30 m. 

calumbae 1 " 4 fl. d. 

cannabis ind 15 " 30 m. 

cantharid 2 " 5 m. 

capsici 8 " 15 m. 

catechu com £ " 2 fl. d. 

chirettae .15 " 60 m. 

cimicifugae 30 " 60 m. 

cinchonse £ " 2 fl. d. 

cinchonae comp. . . . £ " 2 fl. d. 

colchici rad 5 " 15 m. 

colchici sem 6 " 15 m. 

conii 5 " 15 m. 

croci 1 " 2 fl. d. 

cubebae 1 " 2 fl. d. 

digitalis 6 " 15 m. 

ferri acet 15 " 30 m. 

ferri chloridi . . . .15 " 30 m. 

ferri chloridi aether. . .15 " 30 m. 

ferri pomati 20 " 60 m. 

gallse £ " 2 fl. d. 

gelsemii 8 " 15 m. 

guaiaci 30 " 60 m, 

guaiaci ammon. . . .30 "60 m. 

hellebori 10 " 15 m. 

humuli . ■ 1 " 2£ fl. d. 

hydrastis 30 " 90 m. 

hyoscyami fol 15 " 30 m. 

hyoscyami sem. . . .15 "30 m. 

ignatiae 5 " 15 m. 

iodi 5 " 15 m. 

ipecac, et opii .... 5 " 15 m. 

jalapae \ « 2 fl.d. 

kino i " 2 fl.d. 

krameriae £ " 2 fl. d. 

lavand. comp £ " 2 fl. d. 

lobeliae 15 " 45 m. 

lupulini 4 " 2 fl.d. 

matico £ " 2 fl.d. 

moschi 15 " 60 m. 



Remedies. 
Tinct. nucis vomicae 



opu 

opii camph. . . 
phytolaccae . . 
physostigmatis . 
pyrethri . . . 
quassias . . . 

rhei 

rhei arom. . . 
rhei dulc. . . 



sangumariae 

scillae 

serpentaria 

stramon. fol 

stramon. sem 

sumbul 

valer 

valer. ammon 

veratr. vir 

zingiberis 

Tritur. elaterini .... 
Tully's powder .... 

Urethan 

Veratrina 

Vin. aloes 

antim.{ ex P- etanti P? ret ' 
(. emet 

colch. rad 

colch. sem 

ergotae 

ferri amar 

ferri citrat 

expect. . . 

emet. . . . 

opii 

rhei ...'.... 

Zinci acetas 

bromid 

iodid 

oxid 

phosphid 

sulphas emet 

valerianas 



ipecac. 



Dose. 
to 20 m. 
" 15 m. 

" 75 m. 

" 60 m. 

" 15 m. 

" 30 m. 

" 2 fl.d. 

" 8 fl.d. 

" 75 m. 

" 4 fl.d. 

" 70 m. 

" 60 m. 
" 2 fl.d. 

" 15 m. 
"15 m. 

" 30 m. 

" 2 fl.d. 

" 2 fl.d. 

" 10 m. 

" 60 m. 

" \ 

" 10 

" 15 

« l 

iff 

" 2 

" 60 m. 

" 3 d. 

" 20 m. 

" 40 m. 

" 3 fl.d. 

" 1 fl.d. 

" 1 fl.d. 

" 15 m. 

" 6 fl.d. 

" 15 m. 

" 2 fl.d. 

" 2 e. 



g- 
S- 

g- 

g- 

fl.d. 



TABLES OF RELATIVE WEIGHTS AND MEASURES IN 
METRIC AND APOTHECARIES' SYSTEMS. 

(See Oldberg's Manual of Weights and Measures.) 



THE 







Milligrammes 


in Grains. 






Milligramme 




Grain. 


Milligrammes. 


Grain. 


Milligrammes. 


Grain. 


0.1 


= 


6M 


1 


= 


eV 


8 


= 


* 


0.2 


= 


■^(T 


1.2 


== 


l 

50 


9 


= 


* 


0.3 


= 


1 
200 


1.6 


= 


1 

40 


10 


= 


X 


0.4 


= 


1 
T5~0 


2 


= 


A 


12 


= 


1 


0.5 


= 


I 


3 


= 


i 

"20 


16 


= 


I 


0.6 


= 


1 
TOO 


4 


= 


1 
T~5 


20 


= 


* 


0.7 


= 


1 
90 


5 


= 


A 


30 


= 


1 


0.8 


== 


1 
80 


6 


= 


i 

TO 


60 


= 


1 


0.9 


= 


1 

TO 


7 


= 


1 
9 












C 


ENTIGRAMMES 


in Grain 


s. 






Centigrammes 


Grain. 


Centigrammes 


Grains. 


Centigrammes 


Grains. 


(or Cent.) 






(or Cent.) 






(or Cent.) 






1 


= 


6 


6 


= 


1 


18 


= 


3 


2 


= 


i 


7 


= 


li 


25 


= 


4 


3 


= 


i 


9 


= 


i* 


50 


= 


8 


4 


= 


f 


10* 


= 


if 


75 


= 


12 


5 


= 


f 


12 


= 


2 


100 


= 


16 








Grammes in 


Grains. 








Grammes 




Grains. 


Grammes. 




Grains. 


Grammes. 




Grains- 


0.001 


= 


1 
6¥ 


11 


= 


176 


27 


= 


432 


0.010 


= 


* 


12 


= 


192 


28 


= 


448 


0.100 


= 


If 


13 


= 


208 


29 


= 


464 


0.250 


= 


4 


14 


= 


224 


30 


= 


480 


0.500 


= 


8 


15 


= 


240 


31 


— 


496 


0.750 


= 


12 


16 


= 


256 


32 


= 


512 


1 


= 


16 


17 


= 


272 


33 


= 


528 


1.50 


= 


24 


18 


= 


288 


34 


= 


544r 


2 


= 


32 


19 


= 


304 


35 


= 


560 


3 


= 


48 


20 


= 


320 


36 


= 


576 


4 


= 


64 


21 


= 


336 


37 


= 


592 


5 


= 


80 


22 


= 


352 


38 


= 


608 


6 


= 


96 


23 


= 


368 


39 


= 


624 


7 


= 


112 


24 


= 


384 


40 


= 


640 


8 


= 


128 


25 


= 


400 


50 


= 


800 


9 


= 


144 


26 


= 


416 


100 


= 


1600 


10 


= 


160 















640 



RELATIVE WEIGHTS AND MEASURES. 



Cubic Centimetres (or Fluidgrammes) in U. S. Apothecaries' 
Fluidrachms. 



Cubic 




U.S. 


Cubic 




u s. 


Cubic 




u. s. 


Centimetres. 


Fluidrachms. 


Centimetres. 


] 


Tluidrachms. 


Centimetres. 




fluidrachms 


1 


= 


1 


9 


= 


2|- 


16 


= 


4 


2 


= 


i 


10 


= 


2* 


20 


= 


5 


3 


= 


1 


11 


= 


2| 


24 


= 


6 


4 


= 


1 


12 


= 


3 


28 


= 


7 


5 


= 


H 


13 


= 


31 


32 


= 


8 


6 


= 


1* 


14 


= 


3* 


48 


= 


12 


7 


= 


U 


15 


= 


3! 


64 


= 


16 


8 


= 


2 















INDEX OF DRUGS AND REMEDIAL MEASURES. 



Denotes official names and preparations of the B. P. not found in the U. S. P. 



ABORTIFACIENTS, 29 
Absorption of drugs, 26 
Abstractum aconiti, 47 

belladonnse, 88 

conii, 157 

digitalis, 168 

hyoscyami, 196 

ignatise, 199 

jalapse, 216 

nucis vomicae, 256 

podophylii, 285 

senegse, 304 
Abstracts, 22 
Acacia, 39 
*Acacise gummi, 39 
Aceta, 22 
Acetanilide, 39 
Acetate of ammonium, 61 

of copper, 160 

of lead, 222 

of morphine 264 

of potassium, 43 

of sodium, 307 

of zinc, 44 
Acetic acid, 44 
Acetphenetidine, 278 
Acetum cantharidis, 114 

lobelise, 226 

opii, 263 

sanguinariee, 299 

scillae, 311 
Acid infusion of roses, 292 

nitrate of mercury, 239 

tartrate of potassium, 91 
Acidum aceticum, 44 
dilutum, 44 
glaciale, 44 

arseniosum, 76 

benzoicum, 89 

carbolicum, 115 
*carbolicum liquefactum, 118 

chromicum, 138 

citricum, 147 

gallicum, 181 

hydrobromicum dilutum, 99 

hydrochloricum, 193 
dilutum, 194 

hydrocyanicum, 194 

nitricum, 248 
dilutum, 249 

nitro-hydrochloricum, 194, 250 
dilutum, 194, 235, 250 

phosphoricum dilutum, 276 



Acidum salicylicum, 293 
sulphuricum, 318 
aromaticum, 318 
dilutum, 318 
tannicum, 321 
tartaricum, 322 
valerianicum, 331 
Aconite, 45 
*liniment, 47 
*ointment, 47 
*Aconiti folia, 47 

*radix, 47 
Aconitine, 47 
Action of drugs, direct, 19 
duration of, 27 
indirect, 19 
modes of, 19 
Acupuncture, 338 
Adeps benzoinatus. 89 
Adhesive plaster, 288 
Administering drugs, mode of, 19 
Adonidin, 47 
Adonis vernalis, 47 
JEther, 171 
fortior, 171 
*purus, 171 
Agaric, 48 
Agaricin, 48 
Alcohol, 48, 53 

*amylicum, 48, 53 
dilutum, 48, 53 
ethylicum, 48 
phenylic, 115 
Alcoholic extract of belladonna, 8: 
of conium, 157 
of gelsemium, 183 
of hyoscyamus, 196 
Ale, 53 
Alkaloids, 23 
Allium, 53 
Allspice, 55 
Almond bread, 54, 376 
Almonds, 54 
bitter, 54 
sweet, 54 
Aloe, 55 

*barbadensis, 55 
purificata, 55, 56 
socotrina, 55 
*Aloin, 55 
Alteratives, 29, 35 
Alum, 57 
| Alumen, 57 
41 



642 



INDEX OF DRUGS, 



Alumen exsiccatum, 58 
Amber, 58 

American wormseed, 126 
Ammonia, 59 

liniment, 61 
Ammoniac, 64 
Ammoniacum, 64 
Ammoniated mercury, 234 

tincture of guaiac, 188 
of valerian, 330 
Ammonii acetas, 61 

benzoas, 61 

bromidum, 61, 97 

carbonas, 62 

chloridum, 62 

iodidum, 63 

oxalas, 63 

phosphas, 63 

sulphas, 63 

sulphis, 63 

valerianas, 63 
Ammonio-ferric alum, 211 
Ammonium, 61 
Amygdala amara, 54 

dulcis, 54 
Amyl nitrite, 64 
Amy lie alcohol, 48, 53 
Anaesthetics, 29, 35 
Anaphrodisiacs, 29 
Antacids, 29, 35 
Anthelmintics, 29, 35 
Anthrarobin, 65 
Antiarthritics, 29 
Antidotum arsenici, 80, 213 
Antifebrin, 29 
Antihydrotics, 29 
Antimonial powder, 69 
Antimonii et potassii tartras, 66 

sulphidum, 66 

purificatum, 66 
*Antimonium nigrum purificatum, 66 

sulphuratum, 66 

*tartaratum, 66 
Antimony, 66 
Antiperiodics, 29, 35 
Antiphlogistlcs, 29, 35 
Antipyretics, 36 
Antipyrine, 70 
Antiseptics, 338 
Antispasmodics, 36 
Aphrodisiacs, 29 
Apiol, 74 

Apomorphinae hydrochloras, 76 
Apomorphine, 75 
Aqua ammonise, 60 
fortior, 60 

amygdalae am arse, 55 

camphorae, 108 
*chloroformi, 138 

cinnamomi, 146 

creasoti, 161 

menthae piperita, 271 
*pimentae, 55 

rosae, 291 
Aquae, 23 
Arbutin, 330 
*Argenti et potassii nitras, 232 

nitras, 245 
fusus, 245 
dilutus, 245 



Aristol, 76 
Arnica, 76 

fores, 70, 76 

radix, 70, 76 
*rhizoma, 70 , 76 
Aromatic chalk powder, 105 

*chalk powder with opium, 105 

mixture of iron, 211 

powder, 122 

spirit of ammonia, 61 

sulphuric aeid, 319 

syrup of rhubarb, 290 

tincture of rhubarb, 290 
Arseniate of copper, 76 

of iron, 211 

of potassium, 76 

of sodium, 76 
Arsenic, 76 
Arsenicum, 76 
Arsenii iodidum, 80 
Arsenious acid, 76 
Asafoetida, 81 
Aspidium, 82 
Astringents, 29, 35 
Atomization, 20 
Atropinae sulphas, 84, 88 
Atropine, 84, 88 
Auri et sodii chloridum, 186 
Azedarach, 82 



" "OALM OF GILEAD," 328 
-D Balsam of copaiba, 158 
Barbadoes aloes, 55 
Barium chloride, 83 
Barley water, 376 
Basham's mixture, 211 
Bath, Russian, 361 

Turkish, 361 
Bearberry, 330 
Beech wood creasote, 160 
Beef essence, 375 

peptonized, 373 

tea, 375 
Beer, 53 
Belladonna, 84 

folia, 84 

liniment, 88 

ointment, 88 

plaster, 88 

radix, 84 
Benzoate of ammonium, 61 

of bismuth, 88 

of lithium, 225 
Benzoated lard, 89 
Benzoic acid, 88 
Benzoin, 88 
Benzoinum, 88 
Berberine, 105, 192 
Bicarbonate of potassium, 89 

of sodium, 89 
Bichloride of mercury, 234 

as an antiseptic, 338 
Bimuriate of quinine and urea, 144 
Biniodide of mercury, 236 
Binoxide of manganese, 229 
Bismuth, 90 

benzoate, 88 

subgallate, 91 
*Bismuthi carbonas, 90 



INDEX OF DRUGS, 



643 



Bismuthi citras, 90 

et ammonii citras, 83, 90 

salicylate, 91 

subcarbonas, 90 

subgallate, 91 

subnitras, 90 
Bismuthum, 90, 
Bisulpbate of quinine, 144 
Bisulpbide of carbon, 121 
Bitartrate of potassium, 91 
Bitter almonds, 54 

wine of iron, 215 
Bitters, 30 
Black cohosb, 139 

draugbt, 305 

drop, 263 

ginger. 184 

mustard, 243 

oxide of manganese, 229 

pepper, 270 

snake-root, 139 

wash, 236 
Bleeding, 370 
Blood-root, 299 
Blue mass, 236 

ointment, 238 

pill, 236 
Boneset, 178 
Bonjean's ergotin, 171 
Boric acid, 92 
Borate of sodium, 92 
Borated lint. 92 
Borax, 92 
Boroglycerin, 92 
Bran bread, 377 
Brandy, 53 
Brayera, 93 
Bromide of ammonium, 61, 97 

of calcium, 98 

of gold, 98 

of ethyl, 175 

of iron, 211 

of lithium, 98, 225 

of nickel, 91, 98 

of potassium, 94 

of sodium, 99 

of strontium, 99. 312 
Bromides, 94 
Bromine, 99 
Broom, 302 
Brown mixture, 224 
Brucine, 253 
Bryonia, 99 
Buchu, 100 

*folia, 100 
Burgundy pitch, 284 
Burnt alum, 58 
*Butyl- chloral hydras, 162 



CACTUS grandiflorus,'101 
Caffeinse citras, 102 
Caffeine, 102 
Cajuput oil, 103 
Calabar bean, 279 
Calabarine, 279 
Calcium, 103 
Calcii bromidum, 98, 103 

carbonas preecipitatus,'103 
chloridum, 103 



Calcii hydras, 106 

hypophosphis, 103 

phosphas prsecipitatus, 103 
California buckthorn, 121 
Calomel, 236 

ointment, 238 
Calumba, 105 
Calumbine, 105 
Calumbo, 105 
Calx, 106 

cfclorata, 132 
*chlorinata, 132 

sulphurata, 106 
Camphor, 106 

liniment, 108 

water, 108 
Camphora monobromata, 108 
Camphorated tincture of opium,^263 
Camphoric acid, 109 
Canada pitch, 284 
Cannabis Americana, 110 

Indica, 110 
Cantharidal collodion, 113, 156 
Cantharidal cereate, 113 

lininient, 113 

paper, 113 
Cantharidin, 112 
Cantharis, 112 
*Capsici fructus, 114 
Capsicum, 114 

fruit, 114 

plaster, 115 
Carbo iigni, 119 
Carbolic acid, 115 

as an antiseptic, 339 

ointment, 118 
Carbon, 119 

Carbonate of ammonium, 62 
*of bismuth, 90 

of iron, 211 

of lead, 222 

of lithium, 225 

of magnesium, 228 

of potassium, 120 

of zinc, 120 
Carbonei bisulphidum, 120 
Cardamom, 122 

seed, 122 
*Cardamomi semina, 122 
Cardiac sedatives, 30, 36 

stimulants, 30, 36 
Carminatives, 30 
Carron oil, 106 
Caryophyllus, 147 
Cascara cordial, 121 

sagrada, 121 
Cassia fistula, 122 
*Cassise pulpa, 122 
Cathartics, 30 
Castile soap, 306 
Castor oil, 122 
*Cataplasma carbonis,[119 
*conii, 158 
*lini, 181 
*sinapis, 243 
Cataplasms, 23 
Catechu, 124 
Cat's-hair, 178 
Caustic potash, 124 

soda, 124 



644 



INDEX OF DRUGS. 



Cayenne pepper, 114 

Cerates, 23 

Ceratum camphorse, 108 

cantharidis, 113 

extracti cantharidis, 113 

plumbi subacetatis, 223 

resina, 288 
Cerii oxalas, 125 
Chalk mixture, 103 
Champagne, 52 
Charcoal, 119 

poultice, 119 
Charta cantharidis, 113 

*epispastica, 114 

potassii nitratis, 245 

sinapis, 242 
Chartse, 23 
Chenopodium, 126 
Chimaphila, 126 
Chinoidinum, 140 
Chirata, 126 
Chiretta, 126 
Chloral, 127 

*hydras, 121 
Chloralamide, 129 
Chlorate of potassium, 130 
Chloride of ammonium, 62 

of barium, 83 

of calcium, 103 

of gold and sodium, 186 

of iron, 212 

of mercury, corrosive, 234 

of mercury, mild, 236 

of sodium, 131 

of zinc, 132 

as an antiseptic, 342 
Chlorinated lime, 132 
Chlorine gas, 133 
Chlorodyne, 133 
Chloroform, 133 

liniment, 138 
*Chloroformum, 133 

purificatum, 133 

venale, 133 
Cholagogues, 30 
Chromic acid, 138 
Chrysophanic acid, 290 
Chrysarobin, 139 

ointment, 139 
Cimicifuga, 139 

racemosa, 139 

*rhizoma, 139 
Cinchona, 140 

calisaya, 140 

condominea, 140 
*cortex, 140 

flava, 140 

micrantha, 140 

pale, 140 
*pitayensis, 140 

red, 140 

rubra, 140 
*rubra cortex, 140 

succirubra, 140 

yellow, 140 
Cinchonicine, 140 
Cinchonidine, 140 
Cinchonidinse sulphas, 140, 145 
Cinchonidinum, 145 
Cinchoninse sulphas, 140, 145 



Cinchonine, 140 
Cinnamon, 146 
water, 146 
*Cinnamomum cortex, 146 
Citrate of bismuth, 90 

of bismuth and ammonium, 90 
of caffeine, 102 
of iron, 212 

*of iron and ammonium, 212 
of iron and quinine, 213 
of iron and strychnine, 213 
of lithium, 225 
of magnesium, 228 
of potassium, 146 
Citric acid, 147 
Citrine ointment, 240 
Clarets, 53 

Classification of drugs, 35 
Cloves, 147 

Cobalto-nitrate of potassium, 249 
*Coca, 148 

erythroxylon, 148 
*Cocainae hydrochloras, 149 
Cocaine, 148 

phenate, 150 
Codeine, 151 
Cod-liver oil, 151 
Coffee, 154 
Colchicine, 154 
Colchicum, 154 
corns, 154 
seed, 154 
Cold as a remedy, 344 
cream, 291 
pack, 353 
Collodion, 155 
Collodium, 155 

cum cantharide, 113, 156 
flexible, 156 
stypticum, 156 
*vesicans, 156 
Colocynth, 156 
*Colocynthidis pulpa, 156 
Cologne water, 53 
Columbo, 105 

Combination of drugs for effect, 33 
Commercial chloroform, 133 

oxide of zinc, 265 
Compound cathartic pills, 157 
effervescing powder, 303 
*decoction of aloes, 57 

of sarsaparilla, 301 
extract of colocynth, 156 
fluid extract of sarsaparilla, 301 
infusion of gentian, 183 

of senna, 230 
liniment of camphor, 108 

of mustard, 243 
mixture of iron, 212 
of liquorice, 224 
*of senna, 305 
pill of antimony, 69 
of asafoetida, 82 
*of colocynth, 157 
*of conium, 158 
of iron, 211 
of rhubarb, 290 
*of scammony, 302 
*of soap, 263 
*of s uill, 311 



INDEX OF DRUGS. 



645 



*Compound powder of almonds, 55 
*of catechu, 125 
of chalk, 105 
*of cinnamon, 146 
*of elaterin, 169 
*of ipecac, 210 
of jalap, 216 
*of kino, 218 
of liquorice, 224, 305 
of morphine, 264 
*of opium, 263 
of rhuharb, 290 
*of scammony, 302 
solution of iodine, 206 
spirit of ether, 190 
of juniper, 217 
^'suppositories of lead, 222 
syrup of sarsaparilla, 301 

of squills, 70 
tincture of benzoin, 89 
*of camphor, 108 
of cardamom, 122 
of catechu, 125 
*of chloroform, 138 
of cinchona, 145 
of gentian, 183 
*Confectio opii, 263 
*piperis, 270 
rosse, 191, 291 
*scammonii, 302 
sennse, 122, 304 
*sulphuris, 318 
terebinthinse, 329 
Confections, 23 
*Conii folia, 157 
*fructus. 157 
Coniine, 157 
Conium, 157 
Conserves, 22 

Contra-indi cation s|for drugs, 29 
Copaiba, 158 
Copper, 159 
Corrosive chloride of mercury, 234 

sublimate, 234 
Cosmoline, 273 
Counter-irritation, 354 
Counter-irritants, 31, 36 
Coxe's hive syrup, 70, 311 
Cream of tartar, 91 
Creasote, 160 
Creolin, 161 

as an antiseptic, 341 . 
Creta prseparata, 105 
Croton cbloral, 162 
oil, 162 

*liniment, 162 
Cubebic acid, 163 
Cubebin, 163 
Cubebs, 163 
Cupri aceias, 159 
nitras, 159 

sulphas, 159 I 

Cuprum, 159 
*Cusso, 93 
Cyanide of potassium, 163 



DANDELION, 322 
Daturine, 312 
Decoctions, 23 



*Decoctum aloes composi turn, 57 
*cinchonse, 145 
granati radicis, 287 
*hsematoxyli, 189 
*pareir3e, 269 
*quercus, 288 
*sarsse, 301 

*compositum, 301 
sarsaparillee compositum, 301 
*scoparii, 303 
*taraxaci, 322 
Definition of therapeutics, 18 
Demulcents, 31 
Denarcotized opium, 262 
Deodorized tincture of opium, 263 
Dermatol, 91 
Diachylon, 223 
Dialyzed iron, 213 
Diaphoretics, 31, 36 

Diet for cbild six to twelve months old, 374 
one year old, 374 
two years old, 374 
seven years old, 374 
list, 374 
Diethyl-sulphon-dimethyl-metbane, 315 
Digestants, 37 
Digitalin, 168 
Digitalis, 164 
*folii, 164 
Dilute acetic acid, 44 
alcohol, 48 

hydrobromic acid, 99 
hydrochloric acid, 194 
hydrocyanic acid, 194 
nitric acid, 249 

nitro-hydrochloric acid, 194, 252 
phosphoric acid, 276 
solution of subacetate of lead, 222 
sulphuric acid, 319 
Dimethyloxyquinizine, 70 
Dioxide of hydrogen, 266 
Disinfectants, 37 
Disinfection, 357 
Diuretics, 31, 37 
Diuretin, 306 
Donovan's solution, 80 
Dosage, 24 

Double cyanide dressing, "343" 
Dover's powder, 209, 263 
Dried sulpbate of iron, 215 
Drugs, absorption of, 26 
classification of, 35 
duration^of action of, 27 
indications and contra-indications for, 29 
modes of administering, 19 
strength and reliability of, 27 



ECBOLIC acid, 169 
Ecgonine, 148 
Effervescing draught, 147 

*solution of lithium, 226 
"Egg-flip," 53 
Egg-nog, 53 
Elaterin, 168 
Elaterium, 168 
Electuaries, 22 
Eliminators,.31, 37 
Elixirs, 23 
Emetics, 31, 37 



646 



INDEX OF DRUGS, 



Emetine, 210 
Emmenagogues, 31, 37 
Emplastra, 23 

Emplastrum ammoniaci, 64 
cum hydrargyro, 64 
arnicse, 76 
asafoetidee, 82 
belladonnas, 88 
*califaciens, 114 
*cantharidis, 114 
capsici, 115 
*ferri, 216 
hydrargyri, 239 
*opii, 263 

*peroxidum ferri, 216 
picis burgundicae, 284 
picis canadensis, 284 
picis cum cantharide, 113 
plumbi, 223 
*plumbi iodidi, 222 
resinee, 288 
saponis, 306 
Emulsions of bitter almonds, 54 

of sweet almonds, 54 
Endermic medication, 22 
Enema, 20 
*aloes, 57 
*asafoetid8e, 82 
*magnesii sulphatis, 229 
*opii, 263 

Herebinthinae, 329 
Ergot, 169 
Ergotic acid , 169 
Ergotin, 169 
*Ergotinum, 171 
Erigeron, 171 
Erytbroxylon, 148 
Eserine, 279 

♦Essentia menthae piperitae, 271 
Ether, 171 
Ethyl alcohol, 48 
bromide, 175 
iodide, 176 
oxide, 160 
Eucalyptol, 177 
Eucalyptus, 177 
Euonymin, 177 . 
Euonymus, 177 
Eupatorium, 178 
Euphorbia pilulifera, 178 
Europhen, 179 
Exalgine, 180 
Expectorants, 32, 37 
Extracts, 23 
Extractum aconiti, 46 
*aloes barbadensis, 57 

*socotrinae, 57 
arnicse radicis, 76 
*calumbae, 105 
cannabis indicae, 112 
*cascarae sagradae, 121 
cinchonae, 145 
*colchici, 155 
colchici radicis, 155 
colocynthidis, 156 
colocynthidis compositum, 156, 280 
*conii, 157, 158 
digitalis, 168 
ergotse, 171 
euonymi, 178 



Extractum gentianae, 183 
glycyrrhizae, 224 
purum. 224 
haematoxyli, 189 

*hyoscyami, 196 
jaborandi, 282 

*jalapse, 216 
krameriae, 218 
leptandrse, 223 

*lupuli, 192 
mezerei, 242 

*mezerei aethereum, 242 
nucis vomicae, 256 

opii, 262 

*pareiree, 269 

physostigmatis, 280 

podophylli, 285 

quassiae. 288 

rhei, 290 

stramonii, 312 

taraxaci, 322 
*Extractum colchici aceticum, 155 
Extractum belladonnse alcoholicum, 

conii alcoholicum, 157 

*gelsemii alcoholicum, 183 

hyoscyami alcoholicum, 196 
Extractum aconiti fluidum, 46 

arnicae radicis fluidum, 76 

belladonnas fluidum, 88 

brayeree fluidum, 94 

buchu fluidum, 101 

calumbae fluidum, 105 

cannabis indicae fluidum, 112 

capsici fluidum, 115 

chimaphilae fluidum, 126 

chiratae fluidum, 127 

cimicifugae fluidum, 140 

cinchonae fluidum, 145 

colchici radicis fluidum, 155 
seminis fluidum, 155 

conii fluidum, 158 

cubebae fluidum, 163 

digitalis fluidum, 168 

ergotae fluidum, 170 

erythroxyli fluidum, 150 

eucalypti fluidum, 178 

eupatorii fluidum, 178 

gelsemii fluidum, 183 

gentianae fluidum, 183 

geranii fluidum, 184 

glycyrrhizae fluidum, 224 

grindeliae fluidum, 187 

hamamelidis fluidum, 189 

hydrastis fluidum, 193 

hyoscyami fluidum, 196 

ipecacuanhae fluidum, 209 

kraineriae fluidum, 218 

leptandrae fluidum, 223 

lobeliae fluidum, 227 

lupulini fluidum, 192 

mezerei fluidum, 242 

nucis vomicae fluidum, 256 

pareirae fluidum, 269 

pilocarpi fluidum, 282 

podophylli fluidum, 286 

pruni virginianae fluidum, 287 

quassiae fluidum, 288 

rhei fluidum, 290 

rhus glabrae fluidum, 291 

rosae fluidum, 291 



INDEX OF DRUGS 



647 



Extractum sabinse fluidum, 303 

sanguinarise fluidum, 299 

sarsaparillse compositum fluidum, 301 
fluidum, 301 

scillse fluidum, 311 

senegse fluidum, 304 

sennae fluidum, 304 

serpentarise fluidum, 305 

spigelise fluidum, 310 
et sennse fluidum, 310 

stillingise fluidum, 312 

stramonii fluidum, 312 

taraxaci fluidum, 322 

uvae ursi fluidum, 330 

Valerianae fluidum, 330 

veratri viridis fluidum, 334 

ziugiberis fluidum, 184 
*Extractum cascarse sagradse liquidum, 121 
*cinchonse liquidum, 145 
*cocse liquidum, 150 
*ergotse liquidum, 170 
*filicis liquidum, 82 
*glycyrrhizse liquidum, 224 
*opii liquidum, 263 
*pareirse liquidum, 269 
*sarsee liquidum, 301 



FEL bovis, 265 
inspissatum, 265 
purificatum, 265 
Ferri arsenias, 211 
bromidum, 211 
carbonas saccbaratus, 211 
chloridum, 212 
citras, 212 

et ammonii citras, 212 
sulpbas, 211 
tartras, 213 
et potassii tartras, 213 
et quininse citras, 213 
et strychninse citras, 213 
iodidum saccbaratum, 213 
lactas, 214 
oxalas, 214 
oxidum hydratum, 213 

cum magnesio, 80, 213, 227 
*peroxidum bydratum, 216 
pbospbas, 215 
pyropbospbas, 215 
subsulphatis, 214 
sulpbas, 215 

exsiccatus, 215 
*granulata, 215 
prsecipitatus, 215 
valerianas, 215 
Ferrum, 210 

dialysatum, 213 
redactum, 215 
*ta,rtaratum, 213 
*Filix mas, 82 
Flaxseed, 180 
meal, 181 
oil, 180 
poultice, 181 
tea, 180 
Fleabane, 171 

Flemming's tincture ol aconite, 47 
Flexible collodion, 156 
Flowers of sulphur, 316 



i Fluid extracts, 23 
I Flying blister, 355 

Foods for tbe sick, 372 

Foot-batb, 360 

Fowler's solution, 80 

Fuller's lotion, 553 

Fusel oil, 48 



GALEA, 181 
Gallic acid, 181 
ointment, 181 
Garlic, 53 
Gaultberia, 182 
Gelsemine, 182 
Gelsemium, 182 

General therapeutic considerations, 17 
Gentian, 183 
*Gentianse radix, 183 
Geranium, 184 
German chamomile, 230 

soft soap, 306 
Germicides, 357 

Germs, mode of destroying, 338 
Gin, 53 
Ginger, 184 
Glacial acetic acid, 44 
Glauber's salt, 308 
Glycerin, 184 
Glycerins, 20 

*Glycerinum acidi carbolici, 119, 186 
*gallici, 181, 186 
*tannici, 186 

*a.luminis, 58, 186 

*boracis, 93, 186 

*plumbi subacetatis, 186, 223 

*tragacanthee, 186 
Glycerita, 23 
Glycerite of starch, 186 

of yolk of egg, 186 
Giyceritum amyli, 186 

vitelli, 186 
Glycyrrhiza, 224 
*Glycyrrhizse radix, 224 
Glycyrrhizinum ammoniatum, 224 
Goa powder, 139 
Gold, 186 

bromide of, 98 
Goodeli's sumbul pill, 319 
Goulard's extract, 222 
Granatum, 286 

Granulated citrate of magnesium, 228 
Gray powder, 238 
Green iodide of mercury, 240 

soap, 306 
Griffith's pills, 211 
Grindelia, 186 
Guaiac, 187 

wood, 187 
Guaiaci lignum, 187 

resina, 187 
Guaiacol, 188 
Gum arabic, 39 
Gurjun balsam, 188 

oil, 188 



HAMAMELIS, 189 
*H8ematoxyb bgnum, 189 
Heematoxylon, 189 



648 



INDEX OF DRUGS 



Heat, 360 

Heavy magnesium, 228 

Hemlock fruit, 157 

leaves, 157 
Henbane, 196 
Hoffmann's anodyne, 190 
Homatropine hydrobromate, 190 
Home modification of Turkisb bath, 363 
Honey, 191 
*of borax, 93 
of rose, 292 
of squill. 311 
Hop poultice, 191 
Hope's camphor mixture, 192 
Hops, 191 

House mixture, 306 
Humulus, 191 
Husband's magnesia, 227 
Hydrargyri chloridum corrosivum, 234 
mite, 2362 
iodidum rubrum, 236 

viride, 240 
oxidum fiavum, 240 

rubrum, 240 
*perchloridurn, 234 
*subchloridum, 236 
subsulphas flavus, 240 
Hydrargyrum, 230 
ammoniatum, 234 
cum creta, 238 
Hydrastine, 192 
Hydrastis, 192 
Hydrate of chloral, 127 
Hydrated oxide of iron with magnesium, 
213 
peroxide of iron, 216 
sesquioxide of iron, 213 
Hydriodic acid, 206 
Hydrobromate of homatropine, 190 
of hyoscine, 197 
of quinine, 144 
Hydrobromic acid, 99 
Hydrobromide of coniin, 157 
Hydrochlorate of apomorphine, 76 
of cocaine, 149 
of morphine, 264 
of pilocarpine, 282 
• of quinine, 144 
of thallin, 324 
Hydrochloric acid, 193 
Hydrocyanic acid, 194 
Hydrogen dioxide, 266 
peroxide, 266 

as an antiseptic, 342 
Hyoscine, 196 
*Hyoscyami folia, 196 
Hyoscyaminse sulphas, 196 
Hyoscyamine, 196 
Hyoscyamus leaves, 196 
Hypnal, 197 
Hypnotics, 32 
Hypodermic medication, 21 

injection of apormorpnine, 75 
Hypophosphite of calcium, 103 



ICE JACKET, 346 
poultice, 346 
Ichthyol, 198 
Idiosyncrasy, 25 



Ignatia, 198 

bean, 198 
Incompatibilities, 33 
Indian hemp, 110 

poke, 332 
Indications for drugs, 29 
Infusions, 23 
Infusum brayerse, 94 
*buchu, 101 
*calumb8e, 105 
*caryophylli, 148 
*catechu, 125 
*chiratse, 127 
*cinchon8e, 145 
*cinchona3 acidum, 145 
columbse, 105 
*cusso, 94 
digitalis, 168 
*ergotse, 171 

*gentianse compositum, 183 
*jaboraudi, 282 
*kramerise, 218 
*lini, 181 
*lupuli, 192 
pruni virginianse, 287 
*quassise, 288 
*rhei, 290 
*rosee acidum, 292 
*senegse, 304 

compositum, 230, 305 
*serpentaria, 305 
*uvse ursi, 330 
*valeriarjse, 330 
Inhalations, 20 

*Injectio apomorphinse hypodermica/,76 
*ergotini hypodermica, 171 
*morphin£e hypodermica, 264 
Intravenous injection, 364 
Inunctions, 22 

Iodide of ammonium, 63, 199 
of arsenic, 80 
of ethyl, 176 
of iron, 213 
of lead, 222 
of potassium, 199 
of sodium, 202 
of strontium, 312 
Iodine, 202 

liniment, 206 
ointment, 206 
Iodoform, 206 

as an antiseptic, 340 
ointment, 207 
Iodol, 208 
Iodum, 202 
Ipecac, 208 
Iron, 210 

plaster, 216 



* TABORANDI, 280 
J Jalap, 216 
Jalapin, 216 
Jamaica dogwood, 29 
Jamestown weed, 312 
James's powder, 69 
Jequirity, 217 
Jervine, 332 
Juniper, 217 
Joint effects of drugs, 28 



INDEX OF DRUGS. 



649 



KAMALA, 218 
Kaolin, 218 
Kataphoresis, 365 
Kino, 218 
Koosin, 93 
Kousso, 93 
Koumyss, 374 
Krameria, 218 
radix, 218 
Kreolin, 341 



LACTATE OF IRON, 214 
of strontium, 312 
Lactose, 218 

Lady Webster dinner pills, 56 
*Lamellee atropinse, 88 
*cocain8e, 150 
*physostigminse, 280 
Lanolin, 219 
Laudanine, 257 
Laudanum, 263 
Laughing gas, 252 
Lead, 219 

acetate ointment, 222 
plaster, 223 

water and laudanum, 222 
Leeches, 365 

Ledoyen's disinfectant solution, 223 
Lemon juice, 147 
Leptandra, 223 
Levant wormseed, 299 
Light magnesium, 228 
Lignum vitse, 187 
Lime, 106 

water, 106 
*Lini farina, 181 

*semina, 180 
*Linimentum aconiti, 47 
ammonise, 61 
belladonna?, 88 
calcis, 106 
camphorse, 106 - 

*compositum, 106 
cantharidis, 113 
chloroform!, 138 
*crotonis, 163 
*hydrargyri, 239 
*iodi, 206 
*opii, 263 

*potasii iodidi cum sapone, 202 
plumbi subacetatis, 223 
saponis, 108, 306 
sinapis compositum, 243 
terebinthinse, 329 
*aceticum, 329 
Linseed, 180 

poultice, 180 
Linum, 180 
Lipanin, 224 

Liquor acidi arseniosi, 79 
*chromici, 139 
*ammoniffi, 61 
acetatis, 61 
*fortior, 60, 63 
*ammonii citratis, 63 

*fortior, 63 
*antimonii chloridi, 79 
*arsenicalis, 79 
*arsenici hydrochloride, 80 



Liquor arsenii et hydrargyri iodidi, 80 
*atropinse sulphatis, 88 
*bismuthi et ammonii citras, 90 
calcis, 106 

*ch]orinat8e, 133 
*saccharatus, 106 
carbonis detergens, 457 
*epispasticus, 113 
ferri acetatis, 216 
*fortior, 216 
chloridi, 212 
citratis, 212 
*dialysatus, 213 
et quininse citratis, 213 
*perchloridi, 212 

*fortior, 212 

subsulphatis, 214 

tersulphatis, 80 

hydrargyri nitratis, 239 

*perchloridi, 235 
*iodi, 206 

compositus, 206 
*lithise effervescens, 226 
*magnesii carbonatis, 228 

citratis, 228 
*morphinee acetatis, 264 
*hydrochloratis, 264 
sulphatis, 264 
pepsini, 272 
plumbi subacetatis, 222 

dilutus, 222 
potassee, 226 
potassii arsenitis, 79 
citratis, 83, 146 
*permanganas, 272 
sodae, 125 

sodii arseniatis, 80 
zinci chloridi, 132 
Liquorice, 224 

root, 224 
Lister's dressing, 343 
Litharge, 223 
Lithia water, 226 
Lithii bezoas, 225 
bromidum, 98, 225 
carbonas, 225 
citras, 225 
salicylas, 225 
Lithium, 225 
Lobelia, 226 
Log-wood, 189 
*Lotio hydrargyri flava, 247 

*nigra, 236 
Lozenges, 23 
Lugol's solution, 206 
Lunar caustic, 245 
Lupuline, 192 
*Lupulus, 192 
Lycopodium, 227 
Lysol, 227 



MACE, 253 
Magendie's solution, 264 
Magnesia, 227 
levis, 227 
ponderosa, 227 
Magnesii carbonate, 228 
citras, 228 

granulatus, 228 



650 



INDEX OF DRUGS. 



Magnesii carbonas levis, 228 
ponderosa, 228 

sulphas, 228 
Magnesium, 228 
Male fern, 82 
Mandrake, 285 
Manganese, 229 
Mangani oxidum nigrum, 229 

sulphas, 229 
Manganum, 229 
Manna, 229 
Massa copaibse, 158 

hydrargyri, 236 
Matricaria, 230 
May apple, 285 
Meconic acid, 257 
Meconine, 257 
Mel, 191 

*boracis, 93 
*depuratum, 191 

despumatum, 191 

rosse, 191, 292 
Mentha piperata, 270 
Menthol, 253 
Mercurial ointment, 238 

oleate, 240 

pills, 236 

plaster, 239 

suppositories, 239 
Mercury, 230 

with chalk, 238 
Methyl acetanilide, 180 

chloride. 241 
Methylene chloride, 241 
*Mezerei cortex, 242 
Mezereum, 242 

ointment 242 
Mild chloride of mercury, 236 
Milk of asafoetida, 81 

of sulphur, 316 

punch, 52 

peptonized, 372 

sugar, 314 
Mistura ammoniaci, 64 

amygdalae, 54 

asafoetidse, 81 

chloroformi, 138 
*creasoti. 161 

cretee, 103 
*ferri aromatica, 211 

ferri composita, 212 

ferri et ammonii acetatis, 211 

glycyrrhizse composita, 224 
*guaiaci, 188 

potasii citratis, 146 

rhei et sodse, 290 
*scammonii, 302 
*senn8e composita, 305 
*spiritus vini gallici, 53 
Mitigated caustic, 248 
Mode of action of drugs, 19 
Modes of administering drugs, 19 
Monkshood, 45 

Monobronate of camphor, 108 
Monsel's salt, 214 

solution, 214 
Morpninse acetas, 264 

hydrochloras, 264 

sulphas, 264 
Morphine, 264 



Moschus, 242 
Mucilage of acacia, 39 
Mucilago acacise, 39 
Mulled wine, 377 
Muriate of ammonium, 62 

of morphine, 264 
Musk, 242 
Mustard, 243 

papers, 243 

plaster, 243, 356 
Mydriatics, 32 
Myotics, 32 
Myristica, 253 
Myrrh, 243 



■Vf APHTHALIN, 244 
1M Narceine, 257 
Narcotine, 257 
Nervous sedatives, 32 

stimulants, 32, 38 
Neutral mixture, 146 
Nicotine, 327 
Nitrate of copper, 160 

of lead, 223 

of mercury, 239 
*of pilocarpine, 282 

of potassium, 244 

of silver, 245 
Nitre, 244 
Nitric acid, 248 
Nitrite of amyl, 64 

of potassium, 249 
Nitroglycerin, 250 
Nitro-hydrochloric acid, 194, 250 
Nitrous oxide, 252 

Norwood's tincture of veratrum viride, 334 
Nut-gall, 181 
Nutmeg, 253 
Nux vomica, 253 



OIL of tar, 284 
of vitriol, 318 
Ointment of aconite, 47 

of ammoniated mercury, 234 
of antimony, 69 
*of atropine, 88 
of belladonna, 88 
of calomel, 238 
*of cantharides, 114 
of carbonate of lead, 222 
of chrysarobin, 139 
*of creasote, 161 
*of eucalyptus, 178 
of gallic acid, 181 
of galls, 181 

*with opium, 181 
ot iodide of lead, 222 
of potassium, 202 
of iodine, 206 
of iodoform, 207 
*of lead acetate, 222 
of mercury, 238 
of mezereum, 242 
of nitrate of mercury, 240 
of oxide of zinc, 265 
of petrolatum, 273 
*of red iodide of mercury, 236 
oxide of mercury, 236 



INDEX OF DRUGS. 



651 



Ointment of resin, 288 

of rose-water, 291 

of salicylic acid, 297 
*of savine, 302 

of stramonium, 312 

of sulphur, 317 

of tannic acid, 321 

of tar, 285 

*of tartrate of antimony, 69 
*of turpentine, 329 

of veratrine, 332 

of yellow oxide of mercury, 240 
Ointments, 24 
Oleatum hydrargyri, 240 

veratrinse, 332 
Oleoresina aspidii, 82 

capsici, 115 

cubebae, 163 

lupulini, 192 

piperis, 270 

zingiberis, 184 
Oleum amygdalae arnarse, 54 
expressum, 54 

cajuputi, 103 

caryophylli , 147 

chenopodii, 126 

cinnamomi, 146 

copaibae, 158 
*crotonis, 162 

cubebae, 163 

erigerontis, 171 

eucalypti, 177 

gaultberiee, 182 

juniperi, 217 

lini, 180 

menthae piperatse, 270 

morrhuae, 151 

myristicae, 253 

picis liquidae, 284 

pimentae, 55 

phosphoratum, 279 

ricini, 122 

rutae, 292 

sabinae, 301 

santali, 298 
*sinapis, 243 

volatile, 243 

succini, 58 

tanacetum, 322 

terebinthinae, 328 

tiglii, 162 

valerinanae, 330 
Opium, 257 

denarcotized, 262 
Opodeldoc. 306 
Ovalate of ammonium, 63 
Oxalate of cerium, 125 

of iron, 214 
Ox-gall, 265 
Oxide of antimony, 66 

of calcium, 106 

of lead, 223 

of mercury, 240 

of zinc, 265 
Oxygen, 266 

peroxide, 266 

water, 266 
*Oxymel, 191 

*scillae, 311 
Oxytoxics, 32, 38 



PALE cinchona, 140 
rose, 291 
Pancreatin, 267 
Papain, 268 
Papaverine, 257 
Papers, 22 
Papoid, 268 
Paraldehyde, 268 
Parachinanisol, 324 
Paregoric, 263 
Pareira, 269 
Pareirae radix, 269 
Parsley, 74 
Pelletierine, 286 
Pental, 269 
Pepo, 269 
Pepper, 270 
Peppermint, 270 

water, 270 
*Pepsin, 271 

Pepsinum saccharatum, 272 
Peptonized beef, 372 
gruel, 373 
milk, 373 

punch, 373 
oysters, 373 
Permanganate of potassium, 272 
Peroxide of hydrogen, 342 
Petrolatum, 273 
Petroselinum, 74 
Phenacetine, 273 
Phenate of cocaine, 150 
Phenic acid, 115 
Phenocoll, 275 
Phenol, 115 
Phenylic alcohol, 115 
Phlebotomy, 370 
Phosphate of ammonium, 63 
of iron, 215 
of sodium, 276 
of strontium, 312 
Phosphide of zinc, 276 
Phosphorated oil, 279 
Phosphoric acid, 276 
Phosphorus, 276 
*Physostigma, 279 
Physostigmatis semen, 279 
*Physostigmina, 279 
Physostigmine, 279 
Pill of three valerianates, 331 
Pills, 23 
Pilocarpinae hydrochloras, 282 

*nitras, 283 
Pilocarpine, 280 
*Pilula asafoetidae composita, 82 
*colocynthidis composita, 157 

*et hyoscyami, 157 
*conii composita, 158 
*ferri carbonatis, 212 
*hydrargyri, 226 
*ipecacuanhae cum scilla, 210 
phosphori, 279 
*plumbi cum opio, 222 
*saponis composita, 263 
*scammonii composita, 302 
*scillae composita, 311 
Pilulae aloes, 56 

et asafcetidae, 56, 81 

et ferri, 56 

et mastiches, 56 



652 



INDEX OF DRUGS 



Pilulse aloes et myrrhse, 56, 244 

antimonii composite, 69 

asafoetidse, 82 

catharticse compositse, 157 

ferri composite, 211 
iodidi, 214 

opii, 262 

phosphori, 278 ' 

rhei, 290 

compositse, 290 
Pimenta, 55 
Pinkroot, 309 
Piper, 270 

nigrum, 270 
Piperazine, 283 
Piperine, 270 
Pipsissewa, 126 
Piscidia erythrina, 283 
Pitch, 284 
Pix,284 

burgundica, 284 

canadensis, 284 

liquida, 284 
Plaster of ammoniac, 64 

of ammoniac with mercury, 64 

of arnica, 76 

of asafcetida, 82 

of belladonna, 88 

of Burgundy pitch, 284 

of Canada pitch, 284 
*of cantharides, 114 

of capsicum, 115 
*of iron, 216 

of lead, 223 

of mercury, 239 
*of opium, 263 

of resin, 288 

of soap, 306 

of tar, 284 
Plasters, 23 
Plumbi acetas, 222 

carbonas, 222 

iodidum, 222 

nitras, 223 

oxidum, 223 
Plumbum, 219 
Podophyllum, 285 
*Podophylli rhizoma, 285 
Poke-root, 332 
Polygalic acid, 304 
Pomegranate, 286 
Port wine, 53 
Porter, 53 
Potassa, 125 

*caustica, 125 

cum calce, 125 
Potash papers, 244 
Potassii acetas, 43 

bicarbonas, 89 

bitartras, 91 

bromidum, 94 

carbonas, 120 

chloras, 130 

citras. 146 

cynanidum, 163 

iodidum, 199 

nitras, 244 

permanganas, 272 

*tartras acida, 91 
Precipitated carbonate of calcium, 103 



Precipitated carbonate of zinc, 120 
phosphate of calcium, 103 
sulphate of iron, 215 
sulphur, 316 
Prepared chalk, 105 
Pride of China, 82 
Proof spirit, 53 
Protiodide of mercury, 240 
Prunus virginiana, 287 
Prussic acid, 194 
Pseudomorphine, 257 
Ptero carpi lignum, 298 
*Pulvis amygdalae compositus, 55 
antimonialis, 69 
aromaticus, 122, 146 
*catechu compositus, 125 
*cinnamomi compositus, 146 
*cretae aromaticus, 105 
*cum opio, 105 
compositus, 105 
effervescens compositus, 303 
*elaterini compositus, 169 
glycyrrhizae compositus, 305 
*ipecacuanhse compositus, 210, 263. 
et opii, 210, 263 
jalapae compositus, 216 
*kino compositus, 218 
morphinae compositus, 264 
opii, 262 

*compositus, 263 
rhei compositus, 290 
*scammonii compositus, 302 
Pumpkin seed, 269 
Punch, milk, 52 
Punk, 48 
Pure ether, 171 
Purging cassia, 122 
Purified aloes, 55 
chloroform, 133 
ox-gall, 265 

sulphide of antimony, 66 
Pyoktanin, 287 
Pyridine, 327 
Pyrophosphate of iron, 215 



QUASSIA, 287 
*Quassise lignum, 287 
Queen's root, 311 
Quercus alba, 288 

tinctoria, 288 
Quevenne's iron, 215 
Quicksilver, 230 
Quinicine, 140 
Quinidinae sulphas, 145. 
Quininse bimuriatica carbamas, 144 

bisulphas, 144 

hydrobromas, 144 

hydrochloras, 144 

valerianas, 145 
Quinine, 140 



T) ASPBERRY, 292 
-Lt Rectified spirit, 53 
Red cinchona, 140 

iodide of mercury, 236 
oxide of mercury, 240 
precipitate, 234, 240 



INDEX OF DRUGS. 



653 



Red precipitate ointment, 234, 240 

rose, 291 

saunders, 298 

wine, 53 
Reduced iron, 215 

Remedial measures. other than drugs, 
Remedy, cold as a, 344 
Resin, 288 

ointment, 288 

plaster, 223 
Resina, 288 

jalapse, 216 

podophylli, 286 

scammonii, 302 
Resorcin, 289 
Rest cure, 366 
Revulsives, 32 
Rhatany, 218 
Rheum, 289 

*radix, 289 
Rhigolene, 289 
Rhubarb, 289 
Rhus aromatica, 290 

glabra, 291 
Rice water, 376 
Roborants, 32 
Rochelle salt, 291 
Rosa centifolia, 291 

gallica, 291 
Rose water, 291 
Rosin, 288 
Rottlera, 218 
Rubus idaeus, 292 
Rue, 292 

Rules for dosage, 24 
Rum, 53 
Russian bath, 363 



SABINA, 301 
Saccbarated iodide of iron, 213 
pepsin, 272 
*solution of lime, 106 
Saccharin, 292 
Saccharum, 313 
lactis, 313 
officinarum, 313 
*purificatum, 313 
Sal prunella, 244 
Salicylate of bismuth, 293 
of lithium, 225 
of mercury, 293 
of sodium, 297 
Salicylic acid, 293 
*ointment, 297 
Salol, 297 

Salophen, 298 * 

Salt, 131 
Saltpetre, 244 
Salts, 228 
Sandalwood, 298 
Sanguinaria, 299 
Santalum rubrum, 298 
Santonin, 299 

Santoninate of sodium, 299 
Santoninic acid, 299 
Santoninum, 299 
Sapo, 306 
*duris, 306 
*mollis, 306 



Sapo viridis, 306 
*Sarsse radix, 301 
Sarsaparilla, 301 
*Savin8e cacumina, 301 
Savine, 301 

ointment, 302 
Scammonium, 302 
Scammony, 302 
Scilla, 310 
Scillin, 310 
Scillipikrin, 310 
Scillitoxin, 310 
Sclerotinic acid, 169 
*Scopari cacumina, 302 
Scoparius, 302 
Seidlitz powder, 303 
Senega, 304 
Senegse radix, 304 
Senna, 304 

*alexandrina, 304 
*indica, 304 
Serpen taria, 305 

*rhizoma, 305 
Sherry, 53 

Silicate of potassium, 305 
Sinapis alba, 243 
*albse semina, 243 

nigra, 243 
*nigrse semina, 243 
Sinapisma, 243 
Slaked lime, 106 
Smooth sumach, 291 
Snake-weed, 178 
Soap, 306 

liniment, 108, 306 

plaster, 306 
Socotrine aloes, 55 
Soda, 125 

*caustica, 125 
*tartarata, 291 
Sodii acetas, 307 

arsenias, 80 

bicarbonas, 89 

boras, 92 

bromidum, 99 

chloridum, 131 

et potassii tartras, 291 

iodidum, 202 

phosphas, 276 

salicylas, 297 

santoninas, 299 

sulphas, 308 
Sodio-salicylate of theobromine, 306 
Sodium, 307 

ethylate, 308 
Soluble glass, 305 
Solution of acetate of ammonium, 61 

of acetate of iron, 216 
*of morphine, 264 

of ammonia, 61 

of arseniate of potassium, 79 
of sodium, 80 

of arsenious acid, 79 
*of carbonate of magnesium, 228 
*of chloride of antimony, 70 

of zinc, 132 
*of chlorinated lime, 133 

of citrate of ammonium, 63 

of bismuth and ammonium, 90 
of iron, 213 



654 



INDEX OF DRUGS. 



Solution of citrate of iron and quinine, 213 
of potassium, 83 
*of hydrochlorate of morphine, 264 
of iodide of arsenic and mercury, 80 
*of iodine, 206 
of lime, 106 

of nitrate of mercury, 239 
of pepsin, 272 

*of perchloride of mercury, 235 
*of permanganate of potassium, 272 
of potassa, 226 
of soda, 125 

of subacetate of lead, 222 
of sulphate of atropine, 88 
of sulphate of morphine, 264 
Somnal, 308 
Sozoiodol, 308 
Spanish fly, 112 
Sparteine, 302 
Spice plaster, 355 
Spigelia, 309 
Spirit of Mindererus, 61 

of turpentine, 328 
Spiritus setheris compositus, 190 
nitrosi, 319 
ammoniae, 61 

aromaticus, 61 
*foetidus, 61 
*cajuputi, 103 
camphorse, 108 
chloroformi, 138 
cinnamomi, 146 
frumenti, 53 
gaultherise, 182 
•'uniperi, 53, 217 

compositus, 53. 217 
menthae piperita?, 270 
myristicae, 253 
odoratus, 53 
*rectifjcatus, 53 
*tenuior, 53 
vini gallici, 53 
Squill, 310 

Squirting cucumber, 168 
Stillingia, 311 
Stramonii folia, 312 

semen, 312 
Stramonium, 312 
Strength, relative, of drugs, 27 
•Stronger ether, 171 

water of ammonia, 60 
*solution of acetate of ammonia, 63 
*of iron, 212 

*of citrate of ammonia, 63 
*of perchloride of iron, 212 
Strophanthin, 313 
Strophanthus, 313 
Strontium, 312 
bromide, 312 
iodide, 312 
lactate, 312 
phosphate, 312 
Strychninae sulphas, 256 
Strychnine, 253 
Styptic collodion, 156 
Subcarbonate of bismuth, 90 
Subgallate of bismuth, 91 
Sublimed sulphur, 316 
Subnitrate of bismuth, 90 
Subsulphate of iron, 214 



Succinum, 58 
*Succus belladonna?, 88 
*conii, 158 
•hyoscami, 196 
*limonis, 147 
*scoparii, 302 
*taraxaci, 322 
Sugar, 313 

of lead, 222 
of milk, 313 
Sulphate of ammonium, 63 
of atropine, 84, 88 
of cinchonidine, 145 
of cinchonine, 145 
of copper, 159 
of hyoscyamus, 196 
of iron, 215 

and ammonium, 211 
of magnesium, 228 
of manganese, 228 
of morphine, 264 
of quinidine, 145 
of sodium, 308 
of strychnine, 256 
ofthallin, 324 
of zinc, 314 
*Sulphide of ammonium, 63 
of antimony, 66 
of calcium, 315 
Sulphides, 314 

Sulpho-carbolate of zinc, 343 
Sulphonal, 315 
Sulphur, 316 
lotum, 316 
ointment, 317 
praecipitatum, 316 
sublimatum, 316 
Sulphurated antimony, 66 

lime, 106 
Sulphuric acid, 318 

ether, 171 
Sumach, smooth, 291 

sweet, 290 
Sumbul, 319 
pill, 319 
*radix, 319 
*Suppositoria acidi carbolici cum sapone, 119- 
*tannici, 321 
*hydrargyri, 239 
*iodoformi, 208 
*morphinse, 264 

*cum sapone, 264 
*plumbi composita, 222 
Suppositories, 23 
Suspension, 368 
Swamp hellebore, 332 
Sweet almonds, 54 * 
spirit of nitre, 319 
sumach, 290 
Sydenham's laudanum, 263 
Syrup of tar, 285 
Syrupus acacias, 39 
acidi citrici, 147 
acidi hydriodici, 206 
allii, 54 
amygdala?, 54 
calcilactophosphatis, 104 
•chloral, 129 
ferri bromidi, 211 
iodidi, 213 



INDEX OF DRUGS, 



655 



*Syrupus ferri phosphatis, 215 

quininas et strychninas phosphatum,215 
hypophosphatum, 104 

cum ferro, 214 
ipecacuanhas, 209 
kramerias, 218 
♦limonis, 141 
picis liquidas, 285 
pruni virginianas, 287 
rhei, 290 

aromaticus, 290 
rosas, 292 
rubi idasi, 292 

sarsaparillas compositus, 301 
scillas, 311 

compositus, 77, 311 
senegas, 304 
sennas, 305 
zingiberis, 184 



TABACUM, 327 
♦folia, 327 

♦Tabeilas nitroglycerin!, 254 
Tablets, 23 

♦Tablets of nitroglycerin, 254 
Tamarinds, 320 
Tamarindus, 320 
Tanacetum, 322 
Tannate of quinine, 145 
Tannic acid, 321 
Tansy, 322 

tea, 322 
Tar, 2S4 

ointment, 284 

water, 284 
Taraxacum, 322 
Tartar emetic, 66 
Tartaric acid, 322 
Tartrate of antimony and potassium, 

of iron and ammonium, 213 
and potassium, 213 

of potassium and sodium, 291 

oftballin,324 
Terebene, 322 
Terebintbina, 327 
Tbapsia, 325 
Terpinol, 323 
Terpine bydrate, 323 
Tballin, 324 
Tbebaine, 257 
Tbeine, 101 
Therapeutic considerations, 17 

nibilism, 17 
Therapeutics, definition of, 18 
Thiol, 325 
Thiolum liquidum, 325 

sicca, 325 
Thorough wort, 178 
Thymol, 326 

iodide, 326 
Tinctura aconiti, 47 

aloes, 56 

et myrrhas, 56, 244 
♦arnicce, 76 
riorum, 76 

arnicas radix, 76 

asafcetidas, 81 

belladonnas, 88 

benzoini, 89 



Tinctura benzoini composita, 89 

bryonies, 99 
*buchu, 101 

calumbas, 105 
♦camphoras composita, 108, 

cannabis indices, 112 

cantharidis, 113 

capsici, 115 

cardamomi, 122 

composita, 122 
♦catechu, 125 

composita, 125 

chiratas, 127 

♦chloroformi composita, 138 
♦et morphinse, 138, 264 

cimicifugas, 140 

cinchonas, 145 
composita, 145 

cinnamomi, 146 

colchici seminis, 155 

columbas, 105 

conii, 157 

cubebas, 163 

digitalis, 167 
♦ergotas, 171 

ferri chloridi, 212 
♦perchloridi, 212 

gallae. 181 

gelsemii, 183 

gentianee composita, 183 

guaiaci, 187 

ammoniata, 187 

humuli, 192 

hydrastis, 193 

hyoscyami, 196 

ignatias, 199 

iodi, 205 ; colorless, 206 

ipecacuanhas et opii, 246 
♦jaborandi, 282 
♦jalapas, 216 

kino, 218 

kramerias, 218 

lobelias, 226 

♦etherea, 226 
♦lupuli, 192 

moschi, 243 

myrrh as, 244 

nucis vomicas, 256 

opii, 263 

♦ammoniata, 263 
camphorata, 263 
deodorata, 263 

physostigmatis, 280 
♦podophylli, 286 

quassias, 288 
♦quininas ammoniata, 145 

rhei, 290 

aromatica, 290 
dulcis, 290 
♦sabinas, 302 

sanguinarias, 299 

saponis viridis, 306 

scillas, 311 
♦senegas, 304 

sennas, 305 

serpentarias, 305 

stramonii, 312 

sumbul, 319 

valerianas, 330 

ammoniata, 330 



656 



INDEX OF DRUGS 



Tinctura veratri viridis, 334 
zingiberis, 184 
*fortior, 184 
Tinctures, 24 
Tobacco, 327 
Tonics, 32, 38 
Touchwood, 48 
Transfusion, 368 
Triturates, 24 
Trituratio elaterini, 168 
Troches, 24 

*Trochisci acidi benzoici, 89 
tannici, 321 
*bismuthi, 90 
catechu, 125 
cretas, 105 
cubebas, 163 
*ferri redacti, 215 
glycyrrhizas et opii, 225 
ipecacuanhas, 209 
kramerise, 218 
magnesias, 227 
menthse piperita?, 271 
morphinse, 209 

et ipecacuanhas, 209, 264 
opii, 263 

potassi chloratis, 131 
*santonini, 300 
sodii santoninatis, 300 
zingiberis, 184 
Turkish bath, 361 

home mdification of, 362 
Turpentine, 327 
liniment, 329 
♦ointment, 329 
stupe, 328 
Turpeth mineral, 240 



UNGUENTUM acidi carbolici, 118 
gallici, 181 
*salicylici, 297 
tannici, 321 
aconitinas, 47 
*antimonii tartarati,' 69 
aquas rosas, 291 
*atropinas, 88 
belladonnas, 88 
*cantharidis, 114 
*cetacei, 89 
chrysarobini, 139 
*creasoti, 161 
*eucalypti, 178 
gallas, 181 

*cum opio, 181 
hydrargyri, 238 
ammoniati, 234 
*iodidi rubri, 236 
nitratis, 240 
*dilutum, 240 
oxidi flavi, 240 

rubri, 240 
*subchloridi, 238 
iodidi, 206 
iodoformi, 207 
mezerei, 242 
petrolei, 273 
picis liquidse, 285 
*plumbi acetatis, 222 
carbonatis, 222 



*Unguentum plumbi iodidi, 222 
potassii iodidi, 202 
*resinas, 288 
♦sabinse, 302 
stramoni, 312 
sulphuris, 317 
*terebinthinas, 329 
veratrinas, 332 
zinci oxidi, 265 
Ursin, 330 
Uva ursi, 330 
*Uvas ursi folia, 330 



VALERIAN, 330 
Valeriana rhizoma, 330 
Valerianate of ammonium, 63 
of iron, 215 
of quinine, 145 
of zinc, 331 
Valerianic acid, 331 
*Vapor acidi hydrocyanici, 195 
*chlori, 133 
*conii, 158 
*creasoti, 161 
*iodi, 206 
Vaseline, 273 
Vasomotor depressants, 32, 38 

stimulants, 32, 38 
Venesection, 370 
*Veratri viridis rhizoma, 332 
Veratrina, 331 
Veratrine ointment, 332 
Veratroidine, 332 
Veratrum viride, 332 
Vienna paste, 125 
Vinegar, 44 

of lobelia, 226 
of opium, 263 
of sanguinaria, 299 
of squill, 311 
Vinegars, 22 
Vinum album, 53 
aloes, 56 
*antimoniale, 69 
antimonii, 69 
*colchici, 155 
radicis, 155 
serninis, 155 
ergotas, 171 
*ferri, 215 

amarum, 215 
ferri citratis, 215 
ipecacuanhas, 209 
opii, 263 
picis, 285 
portense, 53 
*quininas, 145 
rhei, 290 
rubrum, 53 
tabaci, 327 
xericum, 53 
Virginia snake-root, 305 



WAHOO, 178 
Warburg's tincture, 334 
Warming plaster, 113, 284 
Wash, black, 236 
yellow, 241 



INDEX OF DRUGS. 



657 



Washed sulphur, 316 

Watered toast, 378 

Weaker water of ammonia, 60 

Wet pack, 361 

Whiskey, 53 

White ginger, 184 

mustard, 243 

oak, 288 

precipitate, 234 
ointment, 234 
Wild cherry, 287 
Wine, 53 

of aloes, 56 

of antimony, 69 

of citrate of iron, 215 

of colchicum root, 155 
seed, 155 

of ergot, 171 

of iron, 215 
bitter, 215 

of ipecac, 209 

of opium, 263 

of rhubarb, 290 

of tar, 285 

of tobacco, 327 

whey, 376 
Wines, 24 
Wintergreen, 182 



Witch-hazel, 189 
Wood oil, 188 
Wormseed, 126 



A^ANTHOPUCCINE, 192 



YELLOW cinchona, 140 
jessamine, 182 
oxide of mercury, 240 
sulphate of mercury, 240 
wash, 241 
Young's rule for dosage, 24 



ZINC, 335 
Zinci acetas, 44 
*carbonas, 120 

preecipitatus, 120 
chloridum, 132 
oxidum, 265 

venale, 265 
phosphidum, 276 
sulphas, 314 
valerianas, 331 
Zingiber, 184 



42 



INDEX OF DISEASES AND REMEDIES. 



ABORTION", 379 

Cascara sagrada, or compound liquorice pow- 
der, as a laxative ; if they fail, rhubarb or 
castor oil, 379 

Cimicifuga, fluid extract, gtt. 10 to 20, night 
and morning, as a prophylactic, 380 

Diet ao.d hygiene, 379 

Elaterium, jalap, scammony, strychnine, eri- 
geron, cantharides, contra-indicated, un- 
less very necessary, 378 

Ergot and quinine, in small doses, with per- 
fect rest for one or two weeks, and anti- 
septic irrigation as an after-treatment, 380 

Iodine, applied to the inner surface of uterus, 
after removal of membranes, as a haemo- 
static and antiseptic, 381 

Opium or morphine, best agents to quiet 
uterus if abortion threatens, 380 

Podophyllin, senna, salines in active doses, 
and aloes not to be used if they can be 
avoided, 378 

Quinine, useful in malarial poisoning, as a 
preventive ; in other cases contra-indi- 
cated, 380 

Saline purges contra-indicated, except in 
plethoric women, 378 

Sponges should not be used as tampons, 380 

Tampons of absorbent cotton, dusted with 
iodoform, followed by ergot, if abortion is 
inevitable, 380 

Venesection useful in plethoric women to 
prevent, 380 

Viburnum prunifolium, fluid extract, drachm 
1 to 1%, taken during pregnancy as a pro- 
phylactic, 380 

ABRASIONS. 

Collodion, flexible, painted over part, to render 
wound water-proof and air-tight, 155 

ABSCESS, 381 

Aconite or veratrum viride, in full dose, often 

aborts, 381 
Alcohol, given with milk, in cold abscess, 382 
Belladonna ointment, locally applied, to abort ; 

or tincture, internally, if aconite is not at 

hand, 381 
Calx sulphurata, gr. 1-10 every hour or two, 

useful to abort or cause absorption, 381 
Carbolic acid, minims 5 to 10 of 2 per cent. 

solution, injected into gland threatening 

suppuration, 381 
Cod-liver oil with hypophosphites, quinine and 

iron useful in cold abscess, 382 
Hydrogen peroxide, 10 per cent, solution, to 

wash out cavity of tubercular or slow ab- 
scess, 382 



Incision, if pus forms, followed by irrigation 
with carbolic acid (1 to 20) or bichloride 
solution (1 to 5000) and antiseptic dressing, 
382 

Iodine, locally applied, may abort, 381 

Iodoform gauze, packed into cavity, or ethereal 
solution injected after aspiration, and anti- 
septic dressing, useful in tubercular ab- 
scess, 382 

Lead-water, applied on bread-crumb poultice 
or lint, in early stage, to abort, 381 

Nitrate of silver, gr. 20 to 40 to the ounce, 
locally applied, may abort, 381 

Poultices to assist maturation, 381 

Prescriptions for tonics, in cold abscess, 382 

ACIDITY. 

Ammonia, the most active remedy in gastric 
acidity, contra-indicated if acute irritation 
exists, 60 

Bicarbonate of sodium, in form of effervescing 
powder, valuable in gastric acidity, 90 

Carbonate of calcium, precipitated, best ant- 
acid in intestinal acidity, 103 

Cerium oxalate, used in some cases of gastric 
acidity instead of bismuth, 126 

Charcoal useful in some cases of " sour sto- 
mach," 119 

Lime-water, 106 

ACNE, 383 

Calx sulphurata, gr. 1-10 to 1-8 in pill, thrice 
daily, in pustular acne, 383 

Carbolic acid touched to pustules, after inci- 
sion, 383 

Cod-liver oil, if scrofulosis exists, 383 

Fowler's solution often cures and prevents 
relapse, dose gtt. 1 to 3 thrice daily for a 
month or two, 383 

Green or castile soap used in face-bath night 
and morning, followed by brisk rubbing ; 
if irritation ensues, simple cerate or emul- 
sion of bitter almonds will relieve, 383 

Ichthyol, 20 parts to 100 of lard well rubbed in, 
when induration is great, 383 

Mercurial ointment, to relieve induration, 
several days intervening between its use 
and that of sulphur, 383 

Phosphorus, especially useful in acneindurata, 
278 

Resorcin, gr. 10 to 20 to the ounce of lard, when 
induration is great, 383 

Saline purges, followed by cascara sagrada or 
similar remedy, to regulate bowels, if de- 
pendent upon obstinate constipation, 383 

Sulphur internally and as a wash or ointment 
for women with disordered menstruation, 
prescription for, 383 



660 



INDEX OF DISEASES AND REMEDIES. 



ADENITIS, 383 

Iodine ointment and lard, equal parts, applied 
by inunction, night and morning, or tinc- 
ture, as a paint, stopping application on 
appearance of redness or fluctuation, 384 

Iron, syrup of the iodide, gtt. 5 to 10, in chil- 
dren, 384 

Lancing preferable to allowing abscess to 
break, 384 

Poultice, when redness or fluctuation appears, 
384 

Removal of gland by dissection, if enlarge- 
ment is scrofulous, 384 

Prescription for ointment, 384 

Sulphides, 314 

ALBUMINURIA. (See Bkight's 
Disease.) 

Gallic acid, if due to atony of kidneys, 181 
Strontium lactate, 312 

ALCOHOLISM. (See Poisoning from 
Alcohol.) 

ALOPECIA, 384 

Chrysarobin, drachm % to 1 to lanolin 1 ounce, 
384 

Corrosive sublimate, gr. 2 to 5 to rectified spirit 
1 drachm and oil of turpentine 7 drachms, 
385 

Liquor epispasticus painted over bald spot 
after loose hairs have been depilated, 384 

Pilocarpine, locally applied, often stimulates 
new growth, too much causes small pus- 
tules around follicles ; prescription for, 282 

AMBLYOPIA AND AMAUROSIS, 



Bromide of potassium, 386 
Cauterization of nape of neck, 386 
Correction of optical errors, when arising from 

congenital trouble or non-use of eyes, 3S5 
Cups, wet and dry, 386 
Digitalis in toxic cases, 386 
Electricity, constant current, 386 
Emmenagogues, if due to menstrual disorders, 

385 
Fly-blister to temple in some cases, 385 
Iodide of potassium, 386 
Mercury, when due to syphilis, 386 
Metallo-therapy, may be tried in hysterical 

cases, 385 
Nitrite of amyl, inhalations, 386 
Mtro-glycerin, 386 
Nux vomica in ascending doses in tobacco or 

alcoholic cases, 256 
Pilocarpine, in uraemic amaurosis, also useful 

when due to tobacco and alcohol, 282, 386 
Seton introduced into nape of neck, 385 
Salicylates, 386 
Strychnine, hypodermically, after irritation 

has subsided, 386 

AMENORRHGEA, 386 

Aloes, as a specific, when dependent upon 

constipation, atony of sexual system, or 

anaemia, 56, 386 
Apiol, 3 to 10 minims in capsule thrice daily 

for a week before date of menstruation, 68, 

387 



Arnica, 76 

Binoxide of manganese, gr. 1 to 3, taken for 

two weeks before time of menstruation, 

229 
Cantharides, as a stimulant, if due to atony or 

depression, 112 
Cimicifuga, fluid extract, gtt. 30, at the proper 

time for a flow, 387 
Dewees's emmenagogue mixture, 387 
Eupatorium, in hot infusion, if due to cold, 

178 
Goodell's prescription for, 387 
Griffith's pills, largely used when dependent 

upon anaemia, 211 
Hot sitz-bath, for several nights before period ; 

mustard added often increases its efficacv, 

387 
Iron and myrrh, a standard remedy if due to 

atony or anaemia, 244 
Oil of rue, gtt. 5, in capsule, thrice daily, 387 
Potassium permanganate, useful, but inferior 

to binoxide of manganese, 387 
Salines inferior to aloes if due to constipation, 

386 
Savine, gtt 5, in capsule, thrice daily, to stim- 
ulate uterus, 301 
Tansy, gtt. 5, in capsule thrice daily, or in 

form of tansy tea, 322 

ANAEMIA, 387 

Arsenic, not to exceed gr. 1-16 daily, alone or 
combined with iron, valuable, 78, 389 

Arsenite of copper, 389 

Bitters, simple or aromatic, in conjunction 
with iron, when stomach and intestines 
are atonic, 388 

Blaud's pill, 388 

Bromide of iron, gr. 5 to 20 in syrup, useful 
when there is chorea, 211 

Bullock's blood, fresh or dried, given by enema 
when iron fails, 389 

Chloride of iron, useful because of its tonic 
properties, 212 

Diet and hygiene, 390 

Hypophospbites and phosphate of lime, with 
cod-liver oil, iron, and quinine, when anae- 
mia is due to childbearing and lactation, 
388 

Intravenous injections, 368 

Iodide of iron, syrup of, largely used in stru- 
mous and scrofulous anaemias, 213 

Mercury, bichloride or calomel, especially val- 
uable in syphilitic cases. Inunctions of 
mercurial ointment, once a day or every 
other day, of service in all forms of an- 
aemia, 389 

Quinine in malarial cases, and in tonic doses 
in all other anaemias, 388 

Reduced iron, with laxatives and mineral 
acids for their effects on intestines and 
liver, in uncomplicated cases, 388 

Sulphate of iron or some other astringent prep- 
aration in conjunction with mild purges, 
when tongue is broad, flabby, and white, 
388 

ANAL FISSURE, 390 

Carbolic acid, 1 drop applied to fissure to effect 
cure, in addition when haemorrhoids are 
present a lotion of tannic acid, glycerin, 
and water, 390 



INDEX OF DISEASES AND REMEDIES. 



661 



Castor oil, to relieve bowels if sulphur cannot 
be used, 390 

Flexible collodion painted over spot, may re- 
lieve, 390 

Iodoform suppositories, gr. 2 to 5, relieve pain 
of defalcation ; belladonna, gr. y A to be 
added when there is spasm of sphincter, 
390 

Potassium bromide, drachm 1% to the ounce 
of glycerin, locally applied by means of a 
brush to fissure, highly recommended, 390 

Sulphur, teaspoonful combined with powdered 
cinnamon or aromatic powder at night to 
render passages soft, 390 

ANEURISM, 390 

Aconite, inferior to veratrum viride as a car- 
diac sedative, 391 

Chloroform inhalation if dyspnoea is great, 391 

Digitalis, contra-indicated, 391 

Iodide of potassium, in large doses, associated 
with restricted diet and rest in bed ; more 
valuable in syphilitic than other forms of 
the disease, 200, 391 

Morphine, gr. 1-8, combined with croton chlo- 
ral, gr. 10, in sleeplessness due to pain, 391 

Veratrum viride, gtt. 1 to 2, twice or thrice 
daily if heart is excitable and vascular ten- 
sion high, 391 

ANGINA PECTORIS, 391 

Alcohol, instead of nitrites, when there is vas- 
cular relaxation, 392 

Antipyrine, gr. 20, valuable in some cases. 392 

Arsenic, in full dose long continued, and elimi- 
nation of causes of nerve storm, necessary 
to effect cure, 392 

Cocaine, highly recommended, 392 

Digitalis, when heart is weak, 392 

Ether, in 1-drachm doses in ice- water or cap- 
sule, to nervous females, often aborts, 392 

Hoffmann's anodyne, often the best remedy, 
190 

Morphine, gr. % to >£, hypodermically, when 
nitrite of amyl fails to relieve, 392 

Nitrite of amyl, inhalation of a few drops from 
handkerchief during attack, 392 

Nitrite of sodium or potassium, gr. 3, thrice 
daily, useless unless arterial tension is high 
and heart throbbing, 249 

Nitro-glycerin, gt. 1 of a 1 per cent, solution 
during attack, 280 

Phosphorus, gr. 1-100, after meals, often of 
value, 392 

Stomach-pump may be required when due to 
overloaded stomach, 392 

Tonics combined with careful diet and hygiene 
necessary to a cure, 392 

ANOREXIA, 393 

Bitter tonics, to improve appetite ; contra-indi- 
cated if irritation be present, 393 

Calomel, useful when following acute disease ; 
nitro-muriatic acid, however, generally 
preferable, 238 

Capsicum, in convalescence, acts most favor- 
ably, 114 

Chimaphila, in dropsical patients, as a tonic 
and diuretic. 126 



Gentian, 183 

Prescriptions for tonics, 393 
Quassia, especially valuable when following 
malarial fever, 288 

APHONIA. 

Chlorine gas, 125 

APOPLEXY, 393 

Belladonna, hypodermically, if respiration 

fail, 394 
Croton oil, gt. 1 with sweet oil gtt. 5, as a de- 

pletant cathartic, 393 
Elaterium, gr. %, as a depletant cathartic, 393 
Iodide of potassium, in large doses several days 

after attack, when clot has firmly formed, 

to promote absorption, 394 
Massage and electricity, applied to muscles to 

prevent atrophy ; contra-indicated if in- 
flammation exist, 394 
Mercury, 394 
Mustard plaster to feet, or mustard foot-bath 

and ice to head, keeping head high and 

feet low, 393 
Opium and calomel, gr. */£ of each every four 

hours, if meningitis arise, 394 
Stimulants contra-indicated, 394 
Strychnine,hypodermieally, if respiration fail ; 

also useful to stimulate trophic centres of 

cord, 394 
Venesection, if patient is full-blooded, to pre- 
vent inflammation and further leakage, 393 
Veratrum viride or aconite, when venesection 

is impossible, to lower blood-pressure, 393 

ARGYRIA. 

Iodide of potassium may improve color of 
skin, 246 

ARTHRITIS. 

Bicarbonate of sodium, applied to part on lint 
to allay pain, 90 

Lithium, carbonate and citrate, prevent de- 
posit in joints from rheumatoid arthritis, 
225 

Mustard plaster, as a counter-irritant, 243 

Veratrine ointment, locally applied to rheu- 
matic joints, 331 

ASCARIS LUMBRICOIDES. (See 
Worms.) 

ASCITES. (See Dropsy.) 

ASPHYXIA, 394 

Ammonia, intravenously injected into leg, to 

stimulate heart and respiration, 395 
Artificial respiration, Sylvester's method, 396 
Electricity, only te be used as a peripheral irri- 
tant to restore respiration, 395 
Oxygen inhalations, 266 
Rules regarding position of patient, 396 
Water, cold and hot, alternately dashed over 
body, to stimulate respiration, 396 

ASTHENOPIA, 397 

Eserine or pilocarpine, weak solution, as a 
stimxilant to ciliary muscles, 397 

Glasses, combined with prisms if necessary, to 
correct optical defects, 397 



662 



INDEX OF DISEASES AND REMEDIES 



Massage, rest, salt baths, strychnine, and iron, 

if due to neurasthenia, 397 
Strychnine or tincture of nux vomica in large 

doses, to stimulate ciliary muscles, 397 

ASTHMA, 397 

Aconite, in early stages, 47 

Arsenic, internally or smoked in cigarettes, 
best remedy when mucous membrane is 
at fault, 78 

Belladonna, combined with morphine, very 
useful, 86, 398 

Bromide of potassium or sodium, gr. 30, half 
an hour before retiring, 400 

Cannabis indica, sometimes of service, 111 

Chloral, rarely useful ; if pushed, dangerous, 
129 

Chloroform, inhaled, relaxes spasm ; also use- 
ful in form of liniment applied to breast, 
to abort, 138 

Cocaine, applied to nasal cavities, if due to 
nasal disorders, 400 

Coffee, a cup of strong black, during parox- 
ysm, 102 

Compressed and rarefied air, 400 

Diet and hygiene, 400 

Ethyl iodide, to increase secretion and prevent 
thickening, 177 

Euphorbia pilulifera, % to 1 drachm of the 
fluid extract, 179, 399 

Gelsemium, 183 

Grindelia, fluid extract of, gtt. 20 to 60, or leaves 
soaked in nitre smoked as cigarettes, or 
fumes of burning leaves inhaled, exceed- 
ingly useful, 187, 399 

Iodide of potassium, useful in bronchial, harm 
ful in gastric type, 200 

Lobelia, tincture, gtt. 10 every four hours, it 
attack threaten ; in emetic dose if heart be 
strong, when spasm is present, 399 

Morphine, hypodermically, gr. % to %, alone 
or combined with atropine, 399 

Nitrate of potassium, alone or combined with 
belladonna, in form of cigarettes or inha- 
lations of fumes, often relieves, 245 

Nitrite of amyl, 3 to 6 drops on handkerchief, 
inhaled with care, relieves spasm, 399 

Nitro-glycerin, serviceable if bronchial mu- 
cous membranes are engorged, 250 

Oil of amber, 58 

Oxygen, inhalations when cyanosis is ex- 
treme, 400 

Physostigma, in bronchial asthma, to aid in 
expelling mucus, 280 

Tobacco-smoking often efficacious to patients 
not accustomed to it, 399 

ATONY. 

Calumba, valuable in gastro-intestinal atony 
following fevers, 105 

Capsicum, one of the best remedies in gastric 
atony due to debility and alcoholism, 114 

Cardamom, with bitter tonics and mineral acid 
in gastro-intestinal atony ; prescription 
for, 122 

Chimaphila, useful as a stimulating diuretic 
in atonic renal conditions, 126 

Hydrastis, indicated in atony of mucous mem- 
branes, 193 

Leptandra, in duodenal atony, 224 



Lime salts, useful in atony of mucous mem- 
branes, 106 

Pepper, in atony of genito-urinary mucous 
membranes, 270 

Physostigma, in intestinal and vesical atony, 
280 

Strychnine, in intestinal atony, 255 

BALANITIS AND BALANO- 
POSTHITIS, 496 

Astringent solutions, to cleanse parts, zinc 
chloride (gr. 4 to the ounce) , boric acid 
(1 per cent.), carbolic acid (1.5 per cent.) ; 
silver nitrate (gr. 1 to the ounce) especially 
valuable, 496 

Lead-water, dilute, as a wet dressing, preceded 
by astringent washes, in phimosis ; if in- 
flammation increase, circumcise, 497 

Silver nitrate stick, touched to ulcerations, 496 

Tannin or zinc oxide, as a dusting-powder, 
after retracting prepuce and cleansing 
parts, followed by returning prepuce over 
absorbent cotton, 496 

BALDNESS. (See Alopecia.) 

BED-SORES, 400 

Aloes, glycerole of, as a local application, 56 
Alum, with spirit of camphor and white of 

egg, locally applied, to prevent, 401 
Catechu, with lead acetate, locally applied, to 

harden skin, 401 
Glycerin, application daily, after washing and 

rubbing part, to prevent, 186 
Incision, followed by irrigation, if sores tend 

to burrow, 401 
Salt and whiskey, rubbed over skin to harden 

it (drachms 2 to tbe pint), 401 
Nitrate of silver (gr. 20 to the ounce), painted 

over threatening part, to abort. If ulcers 

form and are sluggish, same solution may 

be used, 401 
Soap plaster, applied to sore after washing 

with bichloride solution (1 to 5000) and 

dusting with iodoform, 401 
Supportive measures and increased amount of 

food, if sloughs are large, 401 
Zinc ointment, on squares of lint, sometimes 

used in lieu of soap plaster, 401 

BILIOUSNESS, 401 

Aconite, antagonizes the poisonous alkaloids 
which cause slow pulse, high arterial ten- 
sion, etc., 404 

Ammonium chloride, grs. 5, thrice daily, if 
associated with catarrh, 404 

Bromides and chloral if nervousness and irri- 
tation are present, 404 

Calomel, gr. % in powder every 15 minutes 
until six are taken, followed in four hours 
by a saline, if stools be light, 403 

Chirata, gr. 5, in hepatic torpor, 404 

Diet, 403 

Euonymus, extract of, dose 3 gr., 404 

Ipecac, powdered, gr. 30 to 60, or apomorphine, 
gr. 1-15 hypodermically, may relieve in 
first stage, 403 

Leptandra, where liver is torpid, 224 

Mustard plaster or cup to nape of neck, if face 
is flushed, foot-bath also of service, 404 



INDEX OF DISEASES AND REMEDIES. 



663 



Nitro-muriatic acid, gtt. 3, thrice daily in 
water, of great service, 404 

Opium, antagonizes the poisonous alkaloid 
which causes hot skin, rapid pulse, dilated 
pupils, etc., 404 

Podophyllin, gr. %, if stools be dark, 403 

Protiodide of mercury, gr. 1-60 to 1-40 in tritu- 
ration, thrice daily, if due to catarrh, 404 

Salines, if attack is sudden, to sweep out poi- 
sonous matter, 403 

Salol or salophen, in 10-gr. doses, useful as an 
intestinal antiseptic, 404 

Stillingia, fluid extract of, dose 20 drops, 404 

BLEPHARITIS, 404 

Boric acid lotion when there is accompany- 
ing conjunctivitis, 405 

Chloral, 5 per cent, solution, to remove scabs 
and crusts, 405 

Creolin, 1 to 2 per cent, solution, useful as a 
wash, 162 

Ointments, dilute citrine, Pagenstecher's (yel- 
low oxide of mercury, 1 gr.; vaseline, 1 
drachm), pyrogallic acid, milk of sulphur 
(3 per cent.), locally applied after removal 
of crusts, 405 

Silver nitrate, touched to crater-like abscesses 
gives good results, 405 

Sodium bicarbonate or biborate, solution (gr. 
8 to ounce)," to remove scabs and crusts, 405 

BOILS, 405 

Belladonna, locally applied to relieve pain and 
inflammation, 405 

Calcium sulphurata hastens pointing and pre- 
vents formation of new ones ; useless in 
boils of diabetes, 97, 405 

Camphorated alcohol, applied over boils in 
formative stage, then wiped dry, followed 
by camphorated oil, to abort, 405 

Carbolic acid, 5 per cent, strength injected into 
apex of boil when formation is assured, to 
abort, 406 

Chloride of calcium, added to poultice, hastens 
maturation, 104 

Collodion painted over inflamed spot, to abort, 
if pus form it may be absorbed, if not, 
evacuate, 405 

Egg-shells baked and eaten, for successive 
crops, 106 

Opium, locally applied to relieve pain and in- 
flammation, 405 

Phosphorus, 278 

Poultices, containing sweet oil and laudanum, 
to assist maturation, 406 

Prescription for ointment, 406 

Silver nitrate (gr. 20 to the ounce), painted over 
part, may abort, 405 

BREATH, FCETID. 

Camphor, as a mouth-wash, 108 

BREASTS, INFLAMED, 406 

Aconite or veratrum viride, to depress circula- 
tion, 406 

Belladonna, internally or as an ointment, be- 
fore and after inflammation, with sponge 
compresses to breast, 406 

Breast-pump, if milk continue to form, 406 

Purges, mild saline, 406 



BONE DISEASE. 

Iodine ointment, diluted %, or tincture, locally 

applied, 203 
Iodide of iron, syrup of, if anaemia exist, 203 

BRIGHT'S DISEASE, ACUTE, 406 

Aconite, to depress circulation, 406 

Blisters contra-indicated, 406 

Bromides or opium, given cautiously, if aconite 
fails to quiet restlessness, 406 

Buttermilk useful, 408 

Cannabis indica, if haematuria is present, also 
to allay pain over kidneys, 406 

Cantharides, % drop doses of tincture, about 
fifth day, when kidneys are atonic, also if 
haematuria is present, 406 

Citrate of potassium and sweet spirit of nitre, 
to increase flow of urine, 407 

Cups or leeches, over loins if urine is scanty, 
407 

Digitalis, with squill or calomel, gradually in- 
creased, followed by gin or compound 
spirit of juniper in later stages, 407 

Elaterium, to relieve dropsy, 406 

Flaxseed tea, as a demulcent, 407 

Gallic acid and ergot, to control excessive 
haematuria, 407 

Iron, if anaemia be present, also to decrease 
albuminuria, 407 

Juniper, to reestablish secretion, after inflam- 
mation has subsided, 217 

Pilocarpine hydrochlorate, gr. 1-20 to 1-8, hypo- 
dermically, if uraemia threatens, repeated 
in fifteen minutes if no sweat appears, 406 

Potassium bitartrate, 92 

Sugar of milk, 408 

Turkish bath, to aid in eliminating effete pro- 
ducts, used with care, 362 

BRIGHT'S DISEASE, CHRONIC, 407 

Bichloride of mercury, 407 

Buttermilk useful, 408 

Cannabis indica, to allay pain over kidneys, 
also if haematuria is present, 111 

Cantharides, particularly useful if due to alco- 
holism, 112 

Capsicum, to check albuminuria, 114 

Chloride of gold and sodium has been recom- 
mended in interstitial forms, 408 

Chloride of iron if anaemia is present; also to 
decrease albuminuria, 408 

Digitalis, to decrease albuminuria, 408 

Elaterium or jalap to relieve dropsy, 407 

Lithium, carbonate or citrate, gr. 5, thrice 
daily, said to be useful in gouty cases, 408 

Milk diet, 407 

Nitro-glycerin useful in ascending doses in 
chronic parenchymatous nephritis, 250 

Oxygen inhalations, 408 

Potassium acetate or bitartrate, alone, or, 
better, with gin or compound infusion of 
juniper, 407 

Potassium iodide, gr. 5, thrice daily, used with 
great care, 201 

Sodium arsenite, gr. 1-20, in gouty cases, 408 

Squill, 407 

Strontium lactate for the relief of albuminuria, 
312 

Tapping to relieve ascites, 408 



6U 



INDEX OF DISEASES AND REMEDIES, 



Turkish and Russian baths, relieve dropsy by- 
increasing action of skin, 407 

BROMIDEOSIS. 
Belladonna, 86 
Borax of great value, 92 

Salicylic acid, used as a dusting powder, pre- 
scription for, 296 

BRONCHITIS, 408 

Aconite, to depress circulation in initial stage, 
47, 410 

Amber, oil of, and olive oil (1 to 3) , applied to 
back and front of chest, in infantile bron- 
chitis, 59 

Ammoniac, useful in old forms devoid of in- 
flammation, 64 

Ammonium carbonate, alone or with the chlo- 
ride, especially useful in children ; gr. 2 to 
10 in syrup of acacia, 62 

Ammonium chloride, in second stage, to stim- 
ulate bronchial tubes, prescription for ; it 
may be applied alone in solution with 
atomizer or inhaled in fumes, 56, 411 

Antimony, to decrease inflammation of first 
stage ; only to be used when patient is 
strong and sthenic, 409 

Apomorphine, gr. 1-10 to 1-5, as an expectorant 
in subacute stage ; if exudation accumu- 
lates rapidly, gr. 1-20 to 1-10 hypodermi- 
cally, as an emetic, 412 

Asafoetida as a stimulating expectorant, 81 

Astringent sprays, often of value if secretion 
be excessive : tannic acid (gr. 2 to 3 to the 
ounce), alum solution (a few grains to 
saturation), Monsel's solution (10 to 15 
drops to the ounce), lead acetate (gr. 1 to 5 
to the ounce), 413 

Balsam of Peru, or tolu, with other drugs, to 
decrease secretion in chronic stage, 412 

Belladonna, to check excessive secretion and 
stimulate respiration, 411 

Benzoic acid, 89 

Bronchitis tent, 409 

Caffeine, or strong coffee, to stimulate respira- 
tion if suffocation threatens, 413 

Camphor, in old or atonic cases, 108 

Codeine, recommended when cough is exces- 
sive, 151 

Creasote, recommended in chronic bronchitis, 
160 

Croton oil and sweet oil (half and half), some- 
times applied to chest, 163 

Cubebs or copaiba, as expectorants, liable to 
derange stomach, 412 

Digitalis, if beart be feeble, 413 

Dry cups applied on each side of the vertebrae, 
at sixth rib, or mustard or spice plaster to 
chest may relieve congestion, 409 

Ethyl iodide, 5 to 10 drops inhaled from a 
handkerchief every few hours in the later 
stages to loosen secretions, 177 

Eucalyptus oil, valuable in later stages ; dose, 
gr. 1 to 5 in capsule every three hours, 412 

Euphorbia pilulifera, half to one drachm of 
fluid extract in chronic bronchitis, 179 

Flaxseed tea, a useful demulcent, 180 

Garlic, boiled in milk or as a poultice, in later 
stages, 411 

Grindelia, very useful in later stages, 187 



Gurjun oil, when a powerful expectorant is 
desired, 188 

Inhalations of steam from boiling water, to 
relieve bronchial soreness, 409 

Ipecac, to promote secretion in first stage, also 
as an emetic when exudation accumulates 
rapidly and suffocation threatens, 410 

Iodide of potassium, often useful when ammo- 
nium salts fail, contra-indicated if secre- 
tion is excessive, 200 

Morphine, gr. 1-24 to 1-12, or chloroform, to 
quiet excessive cough, 410 

Myrrh, with expectorant mixtures, useful in 
later stages, 244 

Mustard foot-bath, with drinks of hot whiskey 
or brandy, in early stages, 409 

Oxygen inhalations, when dyspnoea is great, 
413 

Physostigma, in old persons with dilated tubes, 
as an expectorant and tonic to muscular 
fibres of tubes, 414 

Pilocarpine, to produce copious perspiration 
when patient is strong; nausea may be 
produced, 409 

Potassium citrate with ipecac, to aid in forma- 
tion of secretion, prescriptions, 410 

Prescription for excessive cough, 169 

Pyridine as an inhalation, 411 

Quinine, if fever be persistent. 410 

Resin, inhalations of fumes, said to be useful 
in chronic types, 288 

Sandalwood oil, in later stages, dose 5 to 10 
minims, 412 

Sanguinaria, 299 

Senega, a stimulating expectorant in subacute 
and chronic stages, 304 

Squill, inferior to other drugs' as an expec- 
torant, 412 

Strychnine, to stimulate respiration, if suffo- 
cation threatens, 414 

Tar, 285 

Tartar emetic, as an expectorant, gr. 1-60 
hourly, or 1 drachm of solution (gr. 2 to 
the pint), or as an emetic in sthenic cases, 
69 

Terebene, if ammonium chloride fails ; dose, 5 
to 10 minims in capsule or emulsion ; must 
be stopped if kidneys or stomach are irri- 
tated, or used in an inhaler with equal 
parts of iodide of ethyl and chloroform, 
412 

Terpine hydrate or terpinol in subacute or 
chronic types, to clear tubes of mucus, 323 

Turpentine, inhalations or applied to chest, 
for children, diluted one-half with sweet 
oil, 329 

Veratrum viride, less severe than pilocarpine in 
first stage ; dose, 2 to 3 drops of tincture, 
409 

Water, hot and cold dashes, if death is immi- 
nent from suffocation, 413 

BRONCHOCELE. 

Potassium iodide internally, and tincture of 
iodine externally, best treatment, 201 

BEONCHOEKHffiA. 
Alum, applied in fine spray ; solution, gr. 20 

to the ounce, 58 
Gallic acid, 181 



INDEX OF DISEASES AND REMEDIES. 



665 



BKUISES. 

Arnica, 76 

Liquor plumbi subacetatis, locally applied ; 
strength, 1 to 4 ounces to the pint ; contra- 
indicated, if skin is broken ; also useful as 
lead-water and laudanum (water 16, lead- 
water 4, laudanum 1), 222 

BUBO. 

Carbolic acid solution (gr. 8 to the ounce), 10- 
minim injections, preceded by ether spray, 

x 118 

Incision, at first sign of suppuration, followed 
by washing with either bichloride solution 
(1 to 1000), hydrogen peroxide (% strength), 
or zinc chloride (gr. 40 to the ounce), 417 

Iodine, painted around spot with compress 
and spica bandage, or hot bag over swell- 
ing, 417 

BURNS AND SCALDS, 414 

Boric acid, solution, a useful dressing, 414 

Calcium carbonate, precipitated, as a dressing, 
103 

Cantharides, tincture of, (1 to 40), locally ap- 
plied on lint if burn is not diffuse, 414 

Carbolized sweet oil, cosmoline or simple 
cerate, useful application to counter-irrita- 
tion burns, 357 

Ceratum resinse, as a local application, 288 

Cold cream, as a dressing, 291 

Digitalis, in shock, if circulation fails to re- 
spond to less powerful stimulants, 414 

Ichthyol ointment, 198 

Lead carbonate, as an ointment, or with oil, as 
a dressing, 222 

Lime-water and linseed oil, equal parts, the 
best dressing. Carbolic acid is of service, 
added in proportion of 1 to 20, 414 

Morphine and atropine, gr. ^ to % of former 
to gr. 1-60 of latter, to allay pain, 414 

Opium, to relieve pain, 261 

Potassium citrate with sweet spirit of nitre, if 
urine is high-colored, 415 

Poultice, applied to counter-irritation blister, 
relieves pain ; when blister forms, punc- 
ture if large, allow to break if small, and 
dress with absorbent cotton, 357 

Sodium carbonate, solution, often relieves pain, 
415 

Stimulants, if shock is severe, 414 

Zinc oxide, 265 

CAMPHOR-HABIT. 

Camphor monobromate, 109 

CANCER. 

Arsenic, small doses often repeated, to relieve 
vomiting and pain in gastric cancer, 79 

CANCRUM ORIS. 

Arsenic internally, 79 

Boric acid, as a mouth-wash, 92 

CARBUNCLE. 

Carbolic acid, solution (gr. 8 to the ounce), 

hypodermic injections, to abort, 118 
Phosphorus, 278 



CARIES. 

Lime salts, especially valuable in dental caries 
of nursing women, 104 

CATARRH OF AIR-PASSAGES. 

(See Nasal Catarrh.) 

Alum, applied in fine spray (gr. 20 to the 
ounce), 58 

Arsenic, internally, 79 

Camphor, of service in old or atonic cases, 107 

Sozoiodol, applied locally in 5 per cent, solu- 
tion, 309 

CATARRH OF BLADDER. 

Ammonium benzoate, to render urine acid, 61 
Juniper, a valuable stimulant in chronic cases, 
217 

CATARRH OF UTERUS. 

Hydrastis, 193 

Sozoiodol, in powder, applied by tampon in 
catarrh of cervix uteri, 309 

CEREBRAL DISEASES. 

Blisters, to nape of neck in cerebritis, 355 
Croton oil, in cerebral congestion, 162 
Elaterium, in cerebral congestion, 186 
Phosphorus, often of service in cerebral soften- 
ing, 278 
Veratrum viride, of greatest value in cerebritis 
during stage of hypersemia, after that 
period harmful, 333 

CHANCRE. 

Nitric acid, used as a caustic, surrounding tis- 
sues being protected by oil, 248 

CHANCROID, 415 

Actual cautery, the most destructive caustic, 
415 

Bismuth and zinc oxide, or calomel and bis- 
muth, may be substituted for iodoform as 
a dusting-powder, 416 

Carbolic acid, as a wet dressing (gr. 5 to water 
oz. 1), 416 

Cocaine, 20 per cent, solution, to relieve pain 
of cauterization, 415 

Hot sitz-bath or general warm bath, 417 

Iodoform, the best dusting-powder after cau- 
terizing, also useful as a palliative treat- 
ment, preceded by nitric acid wash (dr.l to 
water Oj). in erosive chancroid, 416 

Iodol or aristol, as a substitute for iodoform, 
416 

Nitric acid, a good caustic, surrounding tissue 
being protected by oil, 415 

Opium, after cauterizing, 417 

Salicylic acid in powder or ointment, 296 

Sulphuric acid with charcoal, a good caustic 
and after-dressing, 416 

Tannin, combined with dusting powder (1 to 
4), if discharge is profuse, 416 

CHAPPING. 

Calcium carbonate, precipitated, as a local pro- 
tective in intertrigo of infants, 103 

Camphor, useful, added to precipitated cal- 
cium carbonate, in intertrigo, 107 

Cold cream, a useful application, 291 



666 



INDEX OF DISEASES AND REMEDIES 



Light magnesia, as a dusting-powder in inter- 
trigo, 228 
Lycopodium, as a dusting-powder, 227 
Zinc oxide, in powder form, useful in inter- 
trigo, 265 

CHILBLAINS. 

Alum, as a wash, 57 

Capsicum, tincture, painted over parts or ap- 
plied as a paper, presciiption for, 115 

Ceratum resinse, 288 

Ichthyol ointment, 198 

Iodine ointment and lard, equal parts, gives 
great relief, 204 

CHLOBOSIS. (See Anjemia.) 

CHOLERA, ASIATIC, 417 

Chloroform, gtt. 3 to 5 hourly, of great service, 
418 

Cocaine in small dose and turpentine stupe to 
belly, to control vomiting, 418 

Fly blister, over vagi, beneath jaw, highly rec- 
ommended, 418 

Friction of body and hot broths, give comfort, 
418 

Morphine, hypodermically, if laudanum can- 
not be taken by the mouth, 418 

Quarantine and strict hygiene, as a prophylac- 
tic, 418 

Sodium chloride, intravenously or by rectum, 
highly recommended, 418 

Sulphuric acid, alone or with laudanum and 
camphor, to control diarrhoea, 417 

" Vagus," treatment of, 418 

Water, with tribasic phosphate of lime and 
potassium chloride added, as a drink, or 
intravenously, 418 

CHOLERA INFANTUM, 419 

Arsenic, to check vomiting, prescription for, 
419 

Brandy, if vomiting is active, and collapse 
threatens, a few drops to drachm of nour- 
ishment. 419 

Castor oil, with paregoric, to empty bowels and 
allay irritation, 419 

Cold drinks, pieces of ice and antipyretics, if 
rectal temperature is above normal, 419 

Diet, 420 

Hot drinks, applications and baths if rectal 
temperature is subnormal, temperature 
being watched, 419 

Irrigation of bowels with salt solution, 420 

Laudanum, gtt. 10, starch- water, drachm 3, by 
enema, and calomel gr. 1-12 or gray pow- 
der gr. % by mouth, to control vomiting 
and purging, if severe, 421 

Mustard or spice plaster, over belly, always 
useful, 421 

Podophyllin, if stools are of peculiar pasty 
color, 420 

Predigested milk, the best food, 419 

Prescriptions for, 421 

CHOLERA MORBUS, 422 

Camphor, 107 



Ipecac, gr. 3 every two hours, often of service 

209 
Mustard or capsicum plaster, over abdomen, 

422 
Prescription for, 422 

CHORDEE. 

Aconite, often relieves, 47 

Belladonna internally and ointment applied 
to under surface of penis, 86 

Bromide of potassium, dr. 1 at bedtime, re- 
peated during night if necessary, 493 

Camphor with bromides, very useful in some 
cases, 107 

Cantharides, gtt. 1, thrice daily, 113 

Hot sitz-bath and steeping penis in hot water 
before retiring, relieves, 360 

Lupulin, gr. 30, 493 

Morphine, gr. y x , with atropine gr. 1-60, hypo- 
dermically into perineum, to relieve, 493 

Opium or belladonna suppositories, to relieve, 
493 

CHOREA, 422 

Arsenic, in ascending doses ; discontinue if 
symptoms of poisoning ensue, 422 

Bromides with chloral, when there is insom- 
nia, prescription for, 423 

Chloral, 128 

Chloroform inhalations when excessive, 138 

Cimicifuga alone, or with iron, very useful, 
423 

Hot pack, at bedtime if muscular jerkings are 
severe, 423 

Monobromated camphor, 109 

Nitro-glycerin, 250 

Salicylates or iodides of value, if associated 
with rheumatism, 423 

Silver oxide and nitrate, occasionally used, 
not reliable, 423 

CHOROIDITIS, 423 

Venesection in early stage, followed by mer- 
cury or potassium iodide, 423 

CINCHONISM. 

Potassium bromide, as a preventive, 97 

CIRRHOSIS OF LIVER. (See Hepatic 
Cirrhosis.) 

COLDS. (See Coryza.) 

COLIC. 

Asafoetida, useful in children, 81 

Chloral and bromide, when severe in children; 

prescription for, 128 
Ether internally, very useful, 175 
Hoffmann's anodyne, 190 
Hyoscyamus, 196 
Matricaria, infusion, to prevent, in teething 

children, 230 
Mustard plaster, % to y 2 strength if skin is 

tender, 243. 
Rue, as a carminative, 292 

COLIC, HEPATIC, 424. 

Belladonna, in full dose, to relax spasm, 86 
Castor oil, with laudanum, to sweep out in- | Chloroform or ether, inhalations to relieve pain 
testines, before diarrhoea mixture is used, during spasm, 424 

422 ' Diet, 424 



INDEX OF DISEASES AND REMEDIES. 



667 



Hot applications over liver, as a relaxant, 424 
Morphine, gr. % or % with atropine gr. 1-60 

hypodermically, to relieve pain, 424 
Olive oi cotton-seed oil, 1% pints, during 

attack ; ether, drachm 1, may he added 

with advantage, 424 
Opium with belladonna, to relieve pain and 

spasm, 260 

COLIC, RENAL. 

Belladonna, in full dose, 86 

Chloroform, a few inhalations often relieve, 

138 
Opium with belladonna relieves spasm and 

pain, 260 

COLLAPSE. 

Digitalis, 167 

Ether, by mouth, inhalations, or hypodermi- 
cally of great service, 175 

CONDYLOMATA. 

Calomel, as a dusting-powder, often removes, 
238 

CONGESTION. 

Croton oil, as a revulsive in cerebral conges- 
tion, 162 
Digitalis, relieves stasis of congested lung in 

typhoid state, 167 
Elaterium, in cerebral congestion, 168 
Ergot of service, especially with digitalis, 170 
Clycerin, on cotton tampon, as a depletant in 

uterine congestion, 186 
Juniper, often relieves congested kidneys, 217 

CONJUNCTIVA, BURNS OF, 425 

Atropine incorporated with liquid vaseline in- 
stilled into eye, to prevent iritis, 425 

Cod-liver oil, instilled into eye after removal 
of foreign matter, 425 

Cold-beater's skin inserted between lids and 
eyeball or breaking up granulations pre- 
vent corneal inflammation, 425 

Neutralization of foreign matter, if acid or 
alkaline, 425 

CONJUNCTIVA, CHEMOSIS OF, 428 

Astringent washes, especially alum, 425 
Nicking swollen tissue with scissors, 425 
Warm moist compresses, 425 

CONJUNCTIVA, HAEMORRHAGE 

BENEATH, 429 

Boric acid or cocaine wash, when conjunctival 
irritation exists, 429 

Massage of globe through closed lid, to aid ab- 
sorption of blood, 429 

CONJUNCTIVA, XEROSIS OF, 429 

Clycerin, almond oil, cod-liver oil or weak al- 
kaline washes, 429 

CONJUNCTIVITIS, CHRONIC, 426 
Boric acid, wash (gr. 10 to the ounce), co- 
caine, gr. 2, may be added if there is no 
corneal ulcer ; for this condition salt, gr. 4 
to the ounce, may be substituted, 427 
Copper, crystal, or a solution (gr. 1 to 3 to the 
ounce), applied to diseased spot, if sub- 
acute, 160 



Correction of refraction error, if it be present, 

427 
Eye-wash, to allay irritation, prescription for, 

92 
Lapis divinis, 427 
Tannin and glycerin (gr. 10 to the ounce), as an 

application, 427 
Yellow oxide of mercury salve or alum crystal, 

useful applications, 427 
Zinc oxide, in powder or the sulphate in the 

form of a wash, 265, 314 

CONJUNCTIVITIS, DIPHTHER- 
ITIC, 428 

Atropine, instilled, 428 

Boric acid or bichloride solution, frequently 
applied in early stages, 428 

Cade, oil of (strength 1 to 10), 428 

Citric acid ointment or lemon juice, locally ap- 
plied, 428 

Hot compresses, 428 

Quinine, solution (gr. 3 to the ounce), 428 

Silver nitrate, same as in purulent conjuncti- 
vitis, 428 

Sulphur, insufflations, 428 

CONJUNCTIVITIS, FOLLIC- 
ULAR, 427 

Alum, crystal applied locally if due to atropine 

instillations, 427 
Astringent and antiseptic lotions, 427 
Calomel, as a dusting-powder, alone or with 

bismuth, aristol or iodoform, 427 
Copper sulphate, as an ointment (gr. % to the 

drachm), 427 

CONJUNCTIVITIS, GRANULAR, 

427 

Atropine, instillations, in acute forms, 428 

Boric acid or salicylic acid, solution, as a 
wash in acute forms, 428 

Boro-glyceride (20 to 50 per cent.), applied to 
chronic granulations, 428 

Carbolic acid, applied pure, to chronic granu- 
lations ; excess removed with water, 427 

Copper sulphate, crystal, applied to chronic 
granulations, 427 

Corrosive sublimate, solution (1 to 200 or 1 to 
500), applied every second day in chronic 
forms, preceded by cocaine ; eyes also 
being irrigated thrice daily with solution 
(1 to 7000), 428 

Crushing granulations, often satisfactory, 428 

Excision of granulations when isolated, 428 

Glycerole of tannin, applied to chronic granu- 
lations, 428 

Jequirity, rarely used, 428 

Leeches, to temple, to reduce inflammation in 
acute stage, 427 

Liquor potassa, beta-naphthol, iodoform, aristol 
in powder or salve, yellow oxide ointment, 
calomel, or hydrastine may be tried, 428 

Scarification, not advisable, 428 

Silver nitrate stick or solution (gr. 10 to the 
ounce), applied daily, if there is discharge ; 
neutralize excess with salt solution, 427 

Yellow oxide of mercury ointment with lard, 
equal parts, in chronic types, 240 



668 



INDEX OF DISEASES AND REMEDIES. 



CONJUNCTIVITIS, LACHRY- 
MAL, 427 
Treatment same as for chronic type. 

CONJUNCTIVITIS, MUCOPURU- 
LENT, 426 
Treatment same as for purulent type. 

CONJUNCTIVITIS, PURU- 
LENT, 425 

Atropine or eserine, if corneal ulcer appears, 
426 

Bichloride of mercury (1 to 7000), or Doric 
acid (saturated solution), as a wash , used 
hourly, 426 

Hot compress, in lieu of cold, if vitality of 
cornea is threatened, 426 

Ice compress, in early stage, to reduce inflam- 
mation, 426 

Leeching useful if inflammation is high, con- 
tra-indicated in infants, 426 

Permanganate of potassium, aqua chlorini, 
sulpho-carbolic acid solution, alum sul- 
phate, zinc sulphate, creolin (1 per cent.) 
or iodoform ointment may be tried, 426 

Peroxide of hydrogen useful as a cleansing 
agent, 426 

Pyoktanin, not satisfactory, 426 

Silver nitrate, stick or solution (gr. 10 to the 
ounce), touched to lids after cleansed of 
pus, excess neutralized with salt solution ; 
2 per cent, solution dropped in newborn 
infant's eyes to prevent, 426 

Sozoiodol (2 to 30), 309 

CONJUNCTIVITIS, SIMPLE, 424 

Alum curd or solution (gr. 4 to 8 to the ounce), 
or application of stick, if there is chronic 
tendency, 425 

Atropine usually unnecessary unless corneal 
ulcer is present, 425 

Boric acid, lotion (gr. 10 to the ounce), 424 

Cold compress, dipped in water, and hama- 
melis (equal parts), to allay inflammation, 
425 

Creolin solution (1 per cent.), 425 

Mercury, bichloride solution (1 to 10,000) if 
discharge is great, 425 

Poultices and bandages contra-indicated, 425 

Pyoktanin (1 to 1000), 425 

Silver nitrate, solution (gr. 2 to 5 to the ounce), 
if there is muco-purulent discharge. If 
discharge is excessive employ gr. 10 to the 
ounce, and neutralize excess with salt solu- 
tion or wash with tepid water, 424 

Smoked glasses, 425 

Tannin and glycerin (gr. 10 to the ounce), or 
alum crystal if there is a chronic tendency, 
425 

Zinc sulphate, solution (gr. 1 to 2 to the ounce), 
alone or with boric acid, if there is chronic 
tendency, 425 

CONSTIPATION, 429. 

Aloes and podophyllin, with other drugs, use- 
ful for temporary use ; contra-indicated for 
continued use ; prescription for, 432 

Alum, useful in some cases, 58 

Belladonna, 87 



Cascara sagrada, the best curative agent, dose 
gtt. 10 to 20 of fluid extract or drachm 1 to 
6 of cordial, 123, 432 

Castor oil, following acute disease in children, 
ultimately harmful in all cases, 432 

Colocynth, jalap, or senna, not to be used con- 
stantly, 431 

Enemata, as a routine treatment harmful, 433 

Glycerin, suppositories or enemata, often used, 
433 

Gymnastic movements, horseback riding, or 
massage, with regulated diet, 430 

Hunyadi, Carlsbad, or Friedrichshall waters, 
rarely of value, 431 

Leptandra, fluid extract of, in intestinal atony, 
224 

Magnesium sulphate by the mouth or by enema, 
229 

Manna, as a laxative fruit for adults or drachms 
1 to 2 to bottle of milk for infants ; harmful 
if long continued, 432 

Mercury as an habitual purgative harmful, 
432 

Opium, 433 

Oxygen water, before retiring, in constipation 
due to intestinal atony, 266 

Phosphate of sodium, useful in rickety chil- 
dren, gr. 2 to 4 in bottle of milk ; or adult, 
gr. 30 to 60, 432 

Rhubarb, usually harmful, in some cases in 
children useful, 431 

Salines, simply to unload bowels, not as a rou- 
tine treatment, 431 

Seidlitz powder, 303 

Soap suppositories useful in children, 306 

Stillingia, recommended, when habitual ; pre- 
scription for, 311 

Sulphur, especially valuable if haemorrhoids 
are present, 317 

Tobacco, sometimes used, 433 

CONVULSIONS. 

Allium, as a poultice over spine or feet in in- 
fantile spinal or cerebral convulsions, 54 

Amyl nitrite, 65 

Chloral with bromide, in infants ; also useful 
alone in ursemic and puerperal convul- 
sions, if no acute renal trouble exists, 128 

CORNS, 423 

Fowler's solution, locally applied, 79 
Salicylic acid, the best application, formula 

for, 433 
Silver nitrate, solution (gr. 60 to the ounce), 

applied to soft corns every four or five 

days, 433 

CORYZA, 433 

Aconite, useful in early stages, 47 

Allium, efficient though disagreeable, in per- 
sistent colds, as a poultice to breast or in 
emulsion or boiled in milk for children, 
53 

Arsenic, taken for months, often cures persist- 
ent colds, 78 

Atropine with morphine, along with the use 
of quinine, in stages of watery secretion, 
436 

Calomel or blue pill followed by a saline, often 
does good, 436 



INDEX OF DISEASES AND REMEDIES. 



669 



Camphor, as a snuff, or inhalation of spirit, or 
fumes, when sneezing and lachrymation 
are excessive, 108 

Cocaine (1 part), morphine (1 part), and bis- 
muth (7 parts), as a snuff, 141 

Cosmoline, as a spray, soothing, 436 

€ubebs, as a snuff during stage of secretion, 
163 

Ferrier's snuff, following alkaline wash, pre- 
scription for, 436 

•Glycerin, with whiskey, not very useful ; ap- 
plied alone, by brush or spray, often of 
service, 186 

Hot mustard foot-bath with hot draught or 
Dover's powder, with rest in bed, may re- 
lieve, 243 

Inhalations of steam charged with cubebs or 
benzoin, 436 

Iodine, by inhalation, 192 

Menthol, very useful, 271 

Prescription for wash, 436 

Prophylactic measures, 436 

Quinine, internally or in spray (gr. 1 to 2 to 
the ounce), 143, 436 

Sweet spirit of nitre, 320 

Tartar emetic, useful in moderate doses, 69 

Turkish bath in early stage, aborts ; later, re- 
lieves ; also a preventive in persons sus- 
ceptible to colds, 435 

Whiskey, 436 

COUGH. 

Acacia, as a mucilaginous drink with flaxseed 
and liquorice, to loosen hacking cough, 
39 

Almonds, essential oil, in emulsion, as a de- 
mulcent in cough of phthisis, 54 

Belladonna, the best remedy in nervous cough, 
86 

Cannabis indica, a useful adjunct to cough 
mixtures, 111 

•Chloroform, useful, added to cough mixtures 
for irritant cough, 138 

Flaxseed tea, alone or with paregoric, a useful 
demulcent in excessive cough, 180 

Gelsemium, 183 

Hydrocyanic acid, highly recommended, pre- 
scription for, 195 

Hyoscyamus, 196 

Iodine, as a paint, over supra-clavicular 
spaces, in irritative cough, 203 

Ipecac, in spray, useful in chronic winter 
cough, 209 

Morphine in wild cherry syrup, useful in irri- 
tative cough and when cough is greater 
than necessary to expel mucus, 261 

Paregoric (1 drachm) in hot water, from which 
the st^m is inhaled, useful in irritative 
form ox cough, 261 

CHAMPS. 

Belladonna, internally or locally as a liniment, 

86 
Chlorodyne, for stomach cramp, 133 
■Ginger, especially useful in menstrual cramp 

due to cold, 184. (See Dysmenorrhea.) 

CROUP, MEMBRANOUS, 446 

(See Diphtheria.) 



CROUP, SPASMODIC, 437 

Aconite useful, 47 

Amyl nitrite, inhalations, if paroxysm is 

severe, 437 
Antimonial wine, drachm 1, to cause vomiting 

if paroxysm is severe, 437 
Belladonna, bromides, chloral, or opium in 

small doses at bedtime, as a preventive, 

437 
Bromides and lactucarium, 437 
Cold cloth around neck, and child placed at 

once in hot bath, air of room being moist- 
ened by steam, 437 
Menthol, useful, 437 
Prophylactic measures, 437 
Sanguinaria, as an emetic, unfavorable, 299 
Spongio-piline or flannel, wet with hot water, 

applied to neck and covered with oiled silk 

or cotton, 437 

CYSTITIS, ACUTE, 438 

Aconite in full dose, with sweet spirit of nitre 
and potassium citrate if there is fever ; pre- 
scription for, 438 

Belladonna, alone or with aconite, especially 
useful if due to cold ; dose, gtt. 5 to 10 
thrice daily, 438 

Boric acid, to render urine acid, 92 

Cannabis indica, preferable to opium for re- 
lieving pain, 438 

Creolin, as a vesical wash (1 to 2 per cent, solu- 
tion) in cystitis of women, 162 

Flaxseed tea, as a demulcent, 180 

Hot compress over bladder, should not contain 
irritants, 438 

Hot sitz-bath and enemata, to relieve bearing- 
down pain, 438 

Hygienic measures, 438 

Laudanum, gtt. 30, to starch-water, oz. 2, in 
enema, to relieve bearing-down pain, 438 

Leeches to perineum or cups to sacrum, 438 

Opium, belladonna, or iodoform suppository, 
to allay bearing-down pain, 438 

Quinine, contra-indicated, 439 

CYSTITIS, CHRONIC, 439 

Arbutin, gr. 3 to 5, or fluid extract of buchu or 
uva ursi, % to 1% drachms, to improve vesi- 
cal mucous membrane when inflammation 
is of subacute type, 439 

Benzoic or boric acid, gr. 5 to 10 in pill, to 
render urine alkaline, 439 

Creolin solution (1 to 2 per cent.), as a vesical 
douche, 440 

Grindelia. as a vesical stimulant, 187 

Mercury, bichloride solution (1 tc 10,000), as an 
injection to cleanse bladder, 439 

Opium suppositories, gr. ^ to %, very useful, 
261 

Potassium salts, except bitartrate, to render 
urine alkaline when mucus is excessive, 
439 

Turpentine, oil of sandalwood, cubeb, or co- 
paiba, useful when vesical atony is great, 
440 

Silver nitrate, solution (gr. 1 to oz. 4, increased 
gradually to gr. 2 to oz. 1), as an injection 
when discharge is muco- purulent, followed 
by salt solution if pain is severe, 439 



670 



INDEX OF DISEASES AND REMEDIES 



Strychnine and cantharides, when vesical 
atony is great, 440 

DEBILITY. 

Arsenic with bitter tonics, very useful, 78 
Calomel, in debility of children, often relieves, 

237 
Eupatorium, a good tonic, 178 
Lime salts, 104 
Phosphorus, of service in sexual debility, 278 

DELIRIUM TREMENS. 

Chloral, of great service used cautiously, 128 
Croton oil, 162 
Hops, 192 

Hyoscine, in insomnia, 197 
Monobromated camphor, when nervous twitch- 
ing is troublesome, 109 
Valerian with morphine, frequently used, 330 

DIABETES INSIPIDUS, 440 

Arsenic, 78 

Belladonna or opium, if due to nervous irri- 
tability, 440 

Carbonate or citrate of lithium, gr. 10, with 
sodium arsenite, gr. 1-30, valuable in gouty 
types, 225 

Ergot, 440 

Gallic acid, alone or with opium, one of the 
best remedies, 440 

Rhus aromatica, highly recommended, 290 

Strychnine and sulphate of iron, as tonics, 440 

DIABETES MELLITUS, 440 

Acidulated water or non-purgative alkaline 
water, to allay thirst, 442 

Almond bread, as a food for diabetics, 54, 376 

Alum, 58 

Bran bread, 377 

Chloride of gold and sodium, gr. 1-10, recom- 
mended, 414 

Codeine, gr. 1 to 5, thrice daily, 441 

Colchicum and iodides, in gouty types, 441 

Diet, 440 

Ergot, highly recommended, 441 

Gallic acid, with opium, one of the best reme- 
dies, 181 

Glycerin or saccharin, as sweetening agents 
to replace sugar, 441 

Iodol, gr. 2 to 6, thrice daily, recommended, 
208 

Iron, lacto-phosphates of lime and sodium, 
strychnine and astringents, if cachexia 
comes on, 442 

Jambul, gr, 5 to 30, once to thrice daily, said 
to be very useful in some cases, 442 

Lime-water, 106 

Lithium carbonate or citrate, with arsenic, 
very useful, if due to gout, 441 

Opium, gr. j^ to y 2 , thrice daily, largely used, 
441 

Purgatives, restricted diet and exercise, if due 
to high living and sedentary habits, 441 

Salicylates and iodide of potassium, if due to 
rheumatic or gouty taint, 441 

DIARRHOEA, 442 

Ammonium chloride, gr. 5, every four hours, 
best remedy in persistent catarrhal states, 



Arsenic, 79 

Belladonna, may be used in serous type, 86 

Bichloride of mercury, gr. 1-100 hourly, if stools 
be slimy and bloody, 446 

Bismuth, with carbolic acid, gtt. 1 or 2, highly 
recommended in serous and summer diar- 
rhoeas, 445 

Bismuthi et ammonii citras, in chronic serous 
types, 90 

Cajuput, gtt. 10 to 20, in serous forms, 103 

Calomel, followed by a saline, useful in sthenic 
cases of summer diarrhoea, 445 

Calumba, in summer and serous diarrhoeas, 
prescription for, 105 

Camphor, useful in serous but never in mucous 
types, 107 

Castor oil, with laudanum and sodium bicar- 
bonate, to unload bowel and render it 
alkaline, 443 

Catechu, alone or with opium, in serous types, 
prescription for, 124 

Chalk mixture, with kino and catechu, in 
serous diarrhoeas, prescription for, 103 

Charcoal, useful in acid and fermentative 
types, 119 

Chirata, nitro-muriatic acid, or, better still, 
nitric acid and cardamoms, in mucous 
type, prescription for, 443 

Chlorodyne, largely used in serous types, 133 

Chloroform, with astringents and opium, very 
useful after removal of irritant cause, 138 

Cinnamon, as a stimulant, in serous types, 146 

Cloves, 148 

Copper sulphate, gr. j£, with opium, gr. 1 in 
pill, or in enema (gr. 5 to 20 to the ounce), 
if due to ulceration, 160 

Diet, for summer diarrhoea, 443 

Ergot, sometimes useful in serous types, 170 

Gallic acid, 181 

Geranium, 1 or 2 roots, boiled in pint of milk,, 
of great service in infantile types, 184 

Ginger, a good addition to diarrhoea mixtures, 
1S4 

Hsematoxylon, useful in children, because of 
agreeable taste, 189 

Hope's camphor mixture, in serous and chol- 
eraic types, 192 

Ipecac, gr. % to >£, thrice daily, useful in sum- 
mer diarrhoea of children, 445 

Iron sulphate, gr. 5 in pill, in chronic types,. 
215 

Kino powder, formula for, 444 

Krameria, useful in serous types, 218 

Lead acetate, with opium and camphor, in 
serous type, prescription for, 222 

Mercury, with chalk or calomel, in hepatic- 
disorder, 444 

Morphine, gr. 1-80 to 1-50, hypodermically, 
often checks summer diarrhoea in chil- 
dren, 262 

Mustard plaster, or other counter-irritants, to- 
abdomen, 443 

Naphthalin, 445 

Nitrate of silver and hyoscyamus, or lead ace- 
tate and opium, in mucous diarrhoea, pre- 
scription for, 443 

Nitric acid, with a bitter tonic, useful in green 
diarrhoea of children ; combined with Fair- 
child's essence of pepsin, relieves chronic 
types in children, 249 



INDEX OF DISEASES AND REMEDIES, 



671 



Nitro-muriatic acid, or podophyllin, gr. 1-50 to 

1-40, in summer diarrhoea, if duodenum is 

at fault, 445 
Nutmeg, useful in prescriptions for serous 

types, 253 
Pepsin with hydrochloric acid, in summer 

diarrhoea, if gastric digestion is deficient, 

445 
Phosphate of sodium, lime salts, and common 

salt in summer types, if rickets is present, 

445 
Potassium iodide, gr. 3 to 5, if catarrhal state 

is ohstinate, 444 
Raspberry leaves used in domestic medicine, 

292 
Rhubarb, often useful, preceding direct treat- 
ment in summer diarrhoea, 290 
Sulphuric acid, especially valuable in serous 

types, prescription for, 444 
Tannic acid, in atonic or serous types, 320 
Tar mixture, highly recommended in obstinate 

types, formula for, 284 
Thymol, naphthalin, and especially sab cy lie 

acid, useful as intestinal antiseptics, in 

summer diarrhoea, 445 
Zinc oxide, in summer types, prescription for, 

266 
Zinc sulphate, 2-grain pills, especially useful 

with opium, or podophyllin, gr. 1-60, in 

serous types, 314 

DIPHTHERIA, 446 

Aconite, in early stages, 47 

Belladonna internally, accompanied by potas- 
sium chlorate, as a paint (5 to 15 grains to 
the ounce) to pharyngeal walls before 
membrane forms, 447 

Boric acid with glycerin (1 to 30) , locally ap- 
plied, to remove membranes, 447 

Carbobc acid (1 to 100) in form of spray or gar- 
gle, 118 

Chlorate of potassium contra-indicated as an 
internal remedy, 449 

Corrosive sublimate or calomel, gr. 1-48 hourly, 
followed by supportive measures, the best 
means to prevent or limit exudation, used 
only in sthenic cases, 447 

Iodine, inhalations, 205 

Iron, tincture of chloride, externally and in- 
ternally, and ice held in mouth and ap- 
plied to glands, if suppuration threatens, 
447, 449 

Lime-water or lactic acid solution (gr. 30 to 
the ounce), in spray, to aid solution of 
membrane, 447 

Monsel's solution, as a topical application, 
valuable, 214 

Oxygen inhalations, atropine, and strychnine, 
and finally intubation or tracheotomy, if 
suffocation threatens, 449 

Peroxide of hydrogen applied on swab or 
spray to remove false membrane, 447 

Potassium chlorate, applied on swab, danger- 
ous internally, 131 

Potassium permanganate, solution (gr. 20 to the 
pint), applied as a swab or as a gargle, 272 

Prescription for wash, 447 

Sulphurous acid fumes as a prophylactic, 447 

Trypsin, applied by swab or spray, to digest 
membrane, 447 



Turpentine, 30 minims, with spirit of ether, 
three times a day. or by inhalation, 448 

DROPSY, 449 

Acupuncture, less favorable than incisions, 
only to be resorted to after other remedies 
fail, 453 

Adonidin, sparteine, or strophanthus, if other 
drugs fail, 453 

Aspiration, in local effusions or dropsy of 
hepatic cirrhosis, 453 

Caffeine, in torpidity of kidneys, 452 

Calomel and digitalis, in renal and cardiac 
types, 452 

Coloc3 7 nth, compound extract of, gr. 2 to 6, 
451 

Copaiba, of service in slow renal types, 158 

Digitalis, gtt. 5 to 10, with cantharides. gtt. 1, 
thrice daily, in renal torpidity due to heart 
trouble, 452 

Elaterium, especially useful in renal dropsv, 
451 

Jalap, compound powder of, gr. 20 to 30, with 
potassium bitartrate, gr. 10 added, espe- 
cially serviceable in renal dropsy, 451 

Magnesium sulphate, in concentrated solu- 
tion, before breakfast, 452 

Milk diet very useful, 452 

Pilocarpine, useful in localized dropsy, contra- 
indicated in cardiac types, 452 

Potassium iodide, in hepatic cirrhosis and 
localized effusions, to remove liquid, 453 

Scoparius, infusion, may be used, 453 

Senega, rarely of value, 304 

Squill with digitalis, prescription for, 310, 452 

Strophanthus, 313 

Sugar of milk, useful as a diuretic, 452 

DYSENTERY, 445 

Alum, internally, 58 

Bichloride of mercury, gr. 1-100 (or gr. % in 
water 5 ounces), teaspoonful hourly till 
relieved, 446 

Calomel, in purgative dose, contra-indicated 
if weakness exists, 448 

Copaiba, 158 

Ergot, useful in bloody stools, 170 

HamameJis, injections, if much blood is pres- 
ent, 446 

Ice-water, injections, if due to inflammation, 
used only in strong persons, 446 

Ipecac, best remedy in acute dysentery, 209 

Lead acetate with opium and camphor, pre- 
scription for, 222 

Magnesium sulphate, 229 

Nitro-hydrochloric acid, if due to defective 
action of secretory glands, 251 

Prescription for enema, 446 

Silver nitrate, rectal injections (gr. 10 to 20 to 
the ounce), if ulcers are chronic : followed 
by salt solution if action is too severe, 446 

Tannic acid (dr. 1 to water Oj), in the form of 
intestinal irrigation, 446 

DYSMENOEKHGEA, 453 

Amyl nitrite, often relieves, 65 

Antipyrine or acetanilide, in neuralgic at- 
tacks, in other cases of doubtful value,. 
454 



672 



INDEX OF DISEASES AND REMEDIES. 



Belladonna, suppository, gr. % of extract, or 
ointment applied, to os ; tincture, inter- 
nally, useful to relax spasm, 453 

Camphor with acetanilide or antifebrin, in 
pill, useful in nervous cases, 107 

Cannabis indica and gelsemium, often of ser- 
vice, 454 

Epsom salts or aloes, if constipation is present, 
453 

Hot sitz-bath, followed by turpentine stupe, 
and Dover's powder, gr. 10, often relieves, 
453 

Iron, strychnine, and quinine, as tonics, with 
rest and horseback riding for anaemic and 
run-down patients, 454 

Opium with belladonna, to relieve spasm and 
pain, 454 

Piscidia erythrina, extract, in the dose of from 
% to 2 fluidrachms, 284 

Potassium bromide, 96 

Water, cold and hot alternately dashed over 
loins in atonic cases, 453 

DYSPEPSIA. (See Indigestion.) 

Arsenic, useful in atonic types associated with 

chronic diarrhoea, 79 
Bismuth, when due to acid fermentation, 90 
Hydrastis, as an antiseptic and curative agent 

in chronic types, 193 
Hydrochloric acid, if gastric secretion is defi- 
cient, 193 
Nitric acid with bitter tonics often relieves in- 
testinal types, 249 
Oxygen-water, often useful in chronic types, 

266 
Permanganate of potassium, 272 
Quassia, useful, if not due to gastritis, 288 
Serpentaria, as a tonic in atonic types, 305 
Strontium bromide in painful dyspepsia, 312 
Terebene, useful as an antiseptic in fermenta- 
tive dyspepsia, 322 

DYSPNOEA, 454 

Ammonium carbonate, as a respiratory and 
cardiac stimulant, 455 

Arsenic, continuously employed, useful in em- 
physema and chronic pulmonary inflam- 
mation, 455 

Dry cupping over back, when due to cardiac 
or pulmonary trouble, 455 

Hyoscine, contra-indicated, 455 

Morphine, gr. y% to % night and morning, 
often cures, when due to nervous or cardiac 
disorders, 455 

Opium, if due to nervous disorders, 455 

Strychnine, in idiopathic types and when due 
to bronchorrhoea in old people, 455 

Thoracentesis, if there is pleural effusion, 455 

EAEACHE, 455 

Cardiac sedatives, 456 

Dobell's solution, in fine spray, if cold in head 

is present, 456 
Heat, dry, applied to head on affected side, 

456 
Leeching behind ear, to relieve pain, 456 



Poultices, oil, and laudanum, contra-indi- 
cated, 456 

Puncture of tympanum, if it bulge, followed 
by careful cleansing and insufflations ot 
boric acid, 456 

Water, hot as can be borne, dropped into ear 
gives great relief, 456 

EAR, DISEASES OF. 

Glycerin, useful to soften impacted cerumen, 

186 
Potassium permanganate, solution, useful in 

otitis media, 272 

ECLAMPSIA, 585 

Chloral and bromide, each 1 drachm, by rec- 
tum, before applying hot pack, 586 

Chloroform, pushed rapidly as possible, at 
onset of attack, 586 

Elaterium, gr. y x , rubbed up with butter, or 
compound jalap powder and calomel, may 
be substituted for croton oil, 586 

Ether, as an anaesthetic, contra-indicated, 586 

Extraction of child rapidly as possible, if at- 
tack comes on during labor, 587 

Ice-bag to head while in warm pack, 586 

Morphine, veratrum viride, and amyl nitrite, 
may be held in reserve, to be used if neces- 
sary, 586 

Pilocarpine, contra-indicated, 586 

Venesection, hot wet pack, and croton oil, gtt. 
2, with sweet oil on tongue, to eliminate 
poison, 586 

ECZEMA, '456 

Arsenic, only when skin is very dry, 458 

Bismuth subgallate in weeping eczema, 91 

Cantharis, internally in small doses, 113 

Carbolic acid ointment (minims 10 to cerate 1 
ounce), to prevent itching, 118, 457 

Dermatol in weeping eczema, 91 

Green soap, as a detergent stimulating appli- 
cation, 306 

Hygienic measures and diet, 456 

Ice- water injections, highly recommended in 
eczema of anal margin, 350 

Ichthyol ointment, highly recommended, 198 

Internal treatment, 458 

Iron, syrup of iodide, in young children with 
ansemia and debility, 213 

Kaolin as a dusting-powder, 218 

Lead, dilute solution of subacetate, a useful 
lotion, 223 

Liquor carbonas detergens, in acute cases, 457 

McCall Anderson's ointment, 457 

Ointments, prescriptions for, 265, 289, 458 

Poultices, or olive oil with carbolic acid (gtt. 
1 to 2 to the ounce), followed by soap and 
water, necessary in some cases to soften 
scales, before use of ointment, 457 

Resorcin ointment (gr. 2 to 30 to the ounce), 
locally applied in subacute types ; in 
chronic form, ointment (gr. 2 to 10 to the 
ounce), 458 

Salicylic acid, ointment (gr. 30 to 60 to lard 1 
ounce), in chronic or weeping types, 458 



INDEX OF DISEASES AND REMEDIES. 



673 



to 1 drachm of the 



Sulphides, bath of, often beneficial, 314 

Tar ointment, in chronic forms, 458 

Thiol, as a dusting-powder, preceded by an 

antiseptic wash, especially suited to moist 

eczema, 325 
Zinc carbonate, as a protective powder in 

weeping eczema, 121 
Zinc oxide, as a dusting-powder or ointment 

in early stages, applied directly or on lint, 

generally preceded by black wash, 457 

EMISSIONS, 459 

Bromide of sodium or potassium, gr/20, at bed- 
time, valuable in spinal irritability, 459 

Chloral, gr. 20, at bedtime, 459 

Cold douches to perineum and scrotum, 459 

Hygienic measures, 459 

Hyoscine, gr. 1-100, of great value, 459 

Potassium citrate, gr. 20, thrice daily, to render 
urine non-irritating, 459 

Strychniue and arsenic, in full dose, of great 
service in genital atony, 459 

Warm bath before retiring, often useful, 459 

EMPHYSEMA OF LUNGS. 

Cod-liver oil, useful, 153 
Ethyl iodide, 177 
Euphorbia pilulifera, 
fluid extract, 178 
Iodide of potassium, 200 
Physostigma, aids in expelling mucus, 279 
Strychnine, 256 

EMPYEMA. 

Iodine, gr. 6 ; potassium iodide, gr. 6 ; water, 
1 pint ; as an irrigating fluid, used daily, 
205 

ENDOCARDITIS, 460 

Aconite, tincture of, gtt. 2 to 3, hourly, in early 
stage of acute sthenic types, 460 

Anti-rheumatics, anti-lithics, or iodides, if due 
to diathetic taint, 460 

Calomel, gr. 1-4, with morphine, gr. 1-10, every 
two hours, in early stages, 460 

Digitalis, to strengthen heart in later stages, 
460 

Iron, tincture of chloride, associated with sup- 
portive treatment, in purulent types, 460 

Leeches or wet cups, in early stages, to abort, 
460 

Lithium citrate, or acetate, or citrate of potas- 
sium, to prevent calcareous deposit in 
valves, 460 

Mercury, in full dose, in sthenic cases, 233 

Veratrum viride, used for same purposes as 
aconite, 460 

ENTERITIS. (See Dysentery and 

DlARRELCEA.) 

EPIDIDYMITIS, 497 

Heat, moisture, and pressure, in later stages, to 
relieve induration, 498 

Horand-Langlebert's dressing, 498 

Ice-bags, 497 

Iodide of potassium, gr. 10 to 20, thrice daily, 
to remove induration, 498 

Iodine, painted over scrotum, said to be bene- 
ficial, 497 



Mercury and belladonna ointments, equal 
parts, or iodine, gr. 4, with lanolin, ounce 
1, locally applied, to relieve induration, 
498 

Punctures, useful to relieve tension and alle- 
viate pain, 498 

Rest in bed, elevation of pelvis and testicles, 
cessation of local gonorrhoeal treatment, 
and administering treatment for acute in- 
flammation, 497 

Silver nitrate, solution, painted over scrotum, 
in early stage, may relieve, 497 

Strapping and suspending testicle, to reduce 
inflammation, 498 

EPILEPSY, 460 

Acetanilide, 43 

Ammonium or sodium nitrite, used to supple- 
ment amyl nitrite, 468 
Amyl nitrite, inhalations, when aura is per- 
ceived and also in status epilepticus to 

relax spasm, 467 
Antifebrin and antipyrine, especially useful in 

chronic cases when bromides fail, 469 
Belladonna, with bromides, recommended, 465 
Bleeding, harmful, except in marked cerebral 

congestion, 470 
Borax, of doubtful value, 470 
Bromate of potassium, 462 
Bromide of ammonium, should be used with 
other drugs, 465 

calcium, 98 

gold, 98 

iron, when anaemia is present, 464 

lithium, highly recommended in some 
cases, 465 

nickel, 465 

potassium, the most reliable, in ascending 
dose, 462 

sodium, not so apt to disorder stomach, 99 
Cannabis indica, 466 
Chloral, alone or with bromides, well diluted, 

after meals, used with care, 469 
Diet, 470 
Digitalis, with bromides, useful in some cases, 

465 
Gelsemium, with cannabis indica, often of 

value, 466 
Hydrobromic acid, liable to derange digestion, 

465 
Iodide of potassium, very useful in syphilitics, 

468 
Iron, in malnutrition, 469 
Mercury, instead of potassium iodide, when 

due to gumma, 468 
Mixed treatment, 462 
Monobromated camphor, 109 
Nitro-glycerin, useful in some cases of petit 

mal, 467 
Opium with gelsemium, only to be lused when 

other remedies fail, 466 
Potassium nitrite, 249 
Quassia injections, when due to worms, if not 

obtainable, sodium chloride solution may 

be used, 470 
Quinine and salicylic acid, contra-indicated, 

470 
Silver nitrate, may be tried when other reme- 
dies fail, 467 
Strontium bromide, 312 



43 



674 



INDEX OF DISEASES AND REMEDIES. 



Strychnine, contra-indicated, except in rare 

cases, 470 
Zinc salts, seldom used of late, 467 

EPIST AXIS, 471 

Acetanilide has been recommended, 43 

Acetic acid, locally applied, to arrest, 44 

Aconite or veratrum viride tincture, gtt. 2 to 4, 
in sthenic cases, followed in thirty minutes 
by smaller doses, if necessary, 47, 471 

Alum powder, pure or half and half with 
starch, as a snuff, 471 

Bacon fat inserted as a plug in nostril, may 
arrest, 472 

Compression of facial artery may be necessary, 
472 

Ergot, turpentine, hamamelis, or oil of erige- 
ron, internally, in slow oozing, 471 

Hot foot-bath, or hot or cold water bags ap- 
plied to dorsal vertebra, may arrest, 472 

Ice applied to nose may arrest, 472 

Ipecac in nauseating doses, recommended, 471 

Monsel's solution, in spray (gtt. 30 to ounces 4), 
only to be tried when other remedies fail ; 
very disagreeable, 471 

Plugging anterior and posterior nares, if neces- 
sary, with cotton or lint soaked in vinegar, 
472 

Tannic acid, in powder or solution, snuffed up 
nostril, 471 

Vinegar or lemon-juice injected into nostril, 
471 

EPITHELIOMA. 

Acid nitrate of mercury, applied to part with 

glass rod, 240 
Arsenious acid and gum acacia (of each one 

ounce, to water rive fluidrachms), locally 

applied, 79 

ERYSIPELAS, 472 

Alcoholic stimulants if patient passes into ty- 
phoid state, 473 

Antipyrine, to control fever, 473 

Belladonna, tincture, internally, minims 4 to 
5, every four hours and locally applied on 
lint or ointment smeared over part, 473 

Bitters and iron, during convalescence, as 
tonics, 473 

Boric acid, as a lotion, 92 

Ichthyol ointment and vaseline, half and half, 
locally applied, preceded by -washing with 
castile soap, followed by bichloride solu- 
tion (1 to 1000), 473 

Iodine, tincture, painted around inflamed 
edges, to arrest, 204 

Iron, tincture of chloride, gtt. 20 to 40, thrice 
daily, best internal treatment, 473 

Pilocarpine, gr. 1-8 to 1-6, hypodermically, con- 
tra-indicated in debility; also injected 
around borders of inflammation in some 
cases, to arrest. 472 

Silver nitrate, solution (gr. 80 to the % ounce), 
applied twice or thrice, to arrest, 473 

Veratrum viride, or aconite, in early stages of 
sthenic cases, 472 

White lead paint, locally applied, when ich- 
thyol is not at hand, 473 



EXHAUSTION AND 
DEPRESSION, 474 

Stimulants, 474 

EXOPHTHALMIC GOITRE. 

Belladonna relieves some cases, 87 
Sparteine, 303 

EYELID, ECCHYMOSIS OF. 

Alum, curd or solution, to prevent discolora- 



tion, 57 



Alcohol, 50 



FAINTING. 



FEET, SWOLLEN, TENDER, OR 
SWEATING, 474 

Arsenic, gr. 1-60 to 1-40, in swelling of old per- 
sons, 474 

Borax, stockings soaked in saturated solution 
and dried, each day, when sweating is ex- 
cessive, 474 

Carbonate of calcium, precipitated, locally ap- 
plied to sweating feet, 104 

Cotton, instead of woollen stockings may aid 
cure. 474 

Hamamelis, distilled, or fluid extract, drachm 
% to 1 of former, or gtt. 10 to 20 of latter, 
474 

Lead plaster and linseed oil, equal parts, ap- 
plied on linen to feet, every third day, for 
sweating, 223 

Prescription for dusting-powder, 474 

Rest, absolute, of feet, may be necessary in 
swollen feet, 474 

Salicylic acid and borax, equal parts, in water 
and glycerin, best application to sweating 
and tender feet, 474 

FELON. 

Bread-crumbs saturated with liquor plumbi 
subacetatis, as a poultice, to abort, 223 

Silver nitrate, solution, applied early, to abort, 
247 

FEVER, 475 

Acetanilide, 42 

Aconite, the best depressant for sthenic types 
in children, 47 

Alcohol, as a systemic support and stimulant 
in low fevers, 50 

Antipyretics, useful in most sthenic fevers, 
often fail in thermic fever, 477, 480 

Antipyrine, 72 

Brand's method, 623 

Cold applications and baths, 346 

Cold packs and baths, in asthenic types, to be 
relied on first; if impi-acti cable, then anti- 
pyretics, 480 

Digitalis, in small dose, valuable in exhaust- 
ing fevers, 167 

Musk, by rectal injections, valuable in low 
stages, 242 

Neutral mixture, useful as a febrifuge, espe- 
cially in children, 146 

Phenacetine, 274 

Salicylic acid and resorcin, inferior to other 
drugs as antipyretics, 289, 204 



INDEX OF DISEASES AND REMEDIES. 



675 



FIBROIDS. 

Ergot, used as an expulsive and curative rem- 
edy, 170 

FLATULENCE. 

Aromatic powder, 146 

Asafoetida, 81 

Camphor, 107 

Capsicum, prevents formation of gas, 114 

Chloroform, gtt. 1 to 2, or spirit, gtt. 10 to 20, 

will relieve, 128 
Cloves, a useful tonic and stimulant, 148 
Hoffmann's anodyne,the hest carminative, 190 
Pepper, 270 
Peppermint, 270 
Potassium permanganate, 272 
Turpentine, prescriptions for, 329 

FRECKLES AND CHLOASMA, 481 

Almonds, emulsion of, supposed to he of value, 

54 
Boric acid, saturated solution, applied same 

as corrosive sublimate wash, 481 
Corrosive sublimate (gr. 1 to 4 to the ounce), 

applied night and morning until irritation 

appears, then stop for some days and again 

renew, 481 
Lactic acid (gr. 10 to the drachm) applied same 

as corrosive sublimate, 481 
Prescription for chloasma of pregnancy, 265 
Prescriptions for, 481 

FURUNCLES. (See Boils.) 

GALACTORRHEA, 583. 

Antipyrine, gr.2%, thrice daily, said to decrease 
secretion, 584 

Caustic, introduced into uterus, successful in 
some cases by inducing menstrual flow, 584 

Chloral should be tried, 584 

Compression of gland with applications of bel- 
ladonna ointment and potassium iodide 
internally, usually relieves, 584 

Diet, 585 

Electricity, generally ineffective, 584 

Ergot, long continued, highly recommended, 
584 

Malt, wineglassful at midday and evening 
meals, useful addition to diet ; pyrophos- 
phate of iron, gr. 5, in addition, if anaemia 
is present, 585 

Warm douches, 584 

GANGRENE. 

Bromine, as an escharotic in hospital gan- 
grene, 99 

Carbolic acid, spray (gtt. 5 to 10 to the ounce), 
useful in pulmonary gangrene, 47 

Nitric acid, to destroy tissue, 248 

GASTRALGIA, 481 

Acetanilide, 42 

Alum, 58 

Arsenic with iron, the most reliable remedy, 

prescription for, 482 
Bismuth and pepsin, 1 to 1% hours after meals, 

to prevent pain, 482 
Bromide of strontium, a valuable new remedy, 

482 



Bromides or valerian, alternated with other 
treatment, if case is neurotic, 482 

Cod-liver oil in emulsion with hypophosphites, 
occasionally better than arsenic and iron, 
482 

Counter-irritation, and a vigorous revulsive, 
especially useful in hysteria, 482 

Cyanide of potassium, dilute hydrocyanic acid 
or chloroform as a substitute for bismuth, 
if it favors constipation, 482 

Diet and hygiene, 481 

Emesis and purgation, when due to indigesti- 
ble food, 481 

Hot applications, stimulating infusions, hot 
brandy or whiskey or laudanum, gtt. 30 to 
60, during acute stage, 481 

Hydrocyanic acid, useful in nervous types, 195 

Massage, enemata, diet, or suppositories of 
gluten, glycerin, or soap, to overcome con- 
stipation, 482 

Menthol, 271 

Nitro-glycerin, 250 

Potassium nitrite, gr. 3 to 5, 249 

Prescriptions for, 482 

Salicylic acid, useful in paroxysmal forms, 295 

GASTRIC CATARRH, ACUTE, 483 

Ammonium muriate, useful in subacute forms 

in children, 63 
Diet, principal point in treatment, 483 
Effervescing draughts.useful in convalescence 

483 
Emetic, mild, to dislodge fermenting mass, if 

present, 483 
Ice, to quench thirst, if anorexia is great, 483 
Iron, if anaemia exists, 483 
Milk, with large percentage of lime-water, 483 
Pepsin and hydrochloric acid, 484 
Salicylic acid, valuable in vomiting, 295 
Salt, in moderation with food, 484 
Seidlitz powder, one-fourth of one powder every 

fifteen minutes, to settle stomach and re- 
move fermenting mucus, 483 
Sodium bicarbonate with gentian, useful in 

convalescence and in children, 483 
Spice poultice, to relieve epigastric distress, 

483 
Tartar emetic, given early, in acute attack of 

children, may abort, 69 

GASTRIC CATARRH, CHRONIC, 

484 

Apomorphine, as an emetic, to throw off mucus, 
75 

Bismuth subnitrate, added to prescription, it 
hyperacidity exists, 484 

Cascara sagrada, if constipation exists, 484 

Diet, such as koumyss, light broths, and mat- 
zoon, 484 

Silver nitrate and hyoscyamus, along with 
counter-irritation and regulated diet, pre- 
scription for, 484 

GASTRIC DILATATION, 484 

Cod-liver oil, by stomach or inunction, if due 

to rhachitis, 485 
Diet, 486 
Enemas, nutrient, often useful, especially in 

older children, 487 
Gentian and calumba, useful as tonics, 487 



676 



INDEX OF DISEASES AND REMEDIES. 



Iodide of iron, syrup of, lacto-phosphates of 
lime, or phosphate of sodium, in strumous 
diathesis, 485 

Lavage, 485 

Physostigma, tincture, gtt. 5 to 10, or extract, 
gr. y % to %, to improve muscular coats, 487 

GASTRIC ULCER, 487 

Bismuth and sodium bicarbonate, as an astrin- 
gent and sedative, and to these may be 
added morphine for pain, 488 

Bromide of sodium, by rectum, to control vom- 
iting, prescription for, 488 

Carlsbad salts, magnesium sulphate, or sodium 
phosphate, for relief of constipation, 488 

Counter-irritation, mild continuous,over belly, 
to relieve pain, 488 

Diet and hygiene, 487 

Ergot or cracked ice, internally, to control 
haemorrhage, 488 

Monsel's solution, cold compresses, turpentine, 
creasote, cocaine, or bismuth may be given 
to check haematemesis, 488 

Prescriptions for, 488 

Morphine for pain or collapse following per- 
foration, 489 

Silver nitrate with hyoscyamus, opium or bel- 
ladonna in pill, half to one hour before 
meals, 488 

Spice plaster, useful as a mild continuous 
counter-irritant, 488 

Stimulants, cardiac, guardedly administered, 
external heat and rubbing, in collapse fol- 
lowing haemorrhage or perforation, 489 

GASTRITIS, ACUTE, 489 

Belladonna internally and flaxseed poultice 
over epigastrium and chest, if collapse 
threatens, 489 
Bismuth, as an astringent and sedative, 90 
Flaxseed tea, a useful demulcent, 180 
Mucilaginous drinks and albuminous sub- 
stances freely given, 489 
Oils, to prevent spread of inflammation, 489 
Opium, in fluid form, to relieve pain and irri- 
tation, 489 
Warm water, internally, or stomach-pump, to 
unload stomach, at onset, 489 

G ASTRO-ENTERITIS, 489 

Castor oil or magnesium sulphate, to sweep 
out poison, 490 

Morphine, hypodermically, to allay pain, fol- 
lowed or preceded by mild, rapidly acting 
emetic, if irritating substance remains, 490 

Opium and sulphuric acid, with hot applica- 
tions or plasters to belly to control irrita- 
tion and diarrhoea, 490 

GASTROINTESTINAL 
CATARRH. 

Diet for seven-year-old child, 374 

Garlic, as a poultice to belly almost equal to 

spice poultice, 54 
. Hydrastis, especially useful if due to alcohol- 
ism, 193 

Sanguinaria, of service if jaundice is present, 
299 

Tar, in 2-gr. pills, 284 



GIDDINESS. 

Cod-liver oil with quinine, valuable in old age, 

152 
Ergot and bromides useful, 170 

GLANDS, DISEASED. 

Ammoniac plaster, as a stimulant to enlarged 

glands, 64 
Ammonium iodide and glycerin (gr. 30 to the 

ounce), locally applied to enlarged tonsils, 

63 
Carbolic acid (2 per cent, solution), injected 

into glands threatening suppuration, 118 
Carbon bisulphide, in enlarged glands, 120 
Cod-liver oil, in lymphatic enlargements, 152 
Ichthyol ointment, valuable as an inunction 

in lymphatic enlargements, 198 
Iodine, the best remedy for enlargements, 203 
Mercury ointment as an inunction in enlarged 

glands, 239 

GLAUCOMA, 490 

Atropine, contra-indicated, 491 

Eserine (gr. 1 to 2 to the ounce), or pilocarpine 

nitrate (gr. 2 to 4 to the ounce), dropped into 

eye if operation is delayed, 491 
Hot compresses, leeches, and opiates to relieve 

pain. 491 
Iridectomy, the only curative treatment, 490 

GLEET. 

Bichloride of mercury, injection (gr. >£ to 
water ounces 6), every three or four hours, 
235 

Cantharidal collodion, applied to under sur- 
face of penis, or perineum, 355 

Cantharides, 113 

Gurjun oil, 188 

Turpentine, internally, 329 

Uva ursi, 330 

GOITRE. (See Bronchocele.) 
GONORRHOEA, ACUTE, 491 

Aconite, gtt. 2, every two or three hours, if 
inflammation is high, 493 

Almond emulsion, diminishes burning on 
urination, 54 

Benzoic acid, with cannabis indica, useful in 
later stages, 89 

Bicarbonate of sodium or potassium citrate, 
gr. 10, after meals, increasing, if necessary ; 
relieves ardor urinae, 493 

Cannabis indica, often used instead of copaiba 
and cubebs, 111 

Carbolic acid (gr. 1 to the ounce), as an injec- 
tion in posterior urethritis, 494 

Cocaine, solution (4 per cent.), instilled into 
urethra before urination, diminishes ardor 
urinae, 493 

Copaiba, to relieve ardor urinae and stimulate 
mucous membrane in later stage, 158 

Cubebs, useful in later stage, 163 

Diet and hygiene, 493 

Erigeron oil, occasionally used instead of co- 
paiba and cubebs, 171 

Eucalyptus, valuable in subacute stages, 178 

Gurjun oil, of value in place of copaiba and 
cubebs, 188 



INDEX OF DISEASES AND REMEDIES. 



677 



Hot sitz-bath, prolonged, and hot-water injec- 
tions, useful in females, 499 

Hydrastis, one of the best remedies, locally 
and internally in later stages; also as a 
vaginal wash for females, 193 

Lead acetate, injection, gr. 1 to 8 to the ounce, 
222 

Lead-water and laudanum, or .alcohol and 
water, applied on a cloth to penis, during 
inflammation, 492 

Mercury, bichloride (1 to 20,000 or 1 to 40,000), 
in large quantities to flush urethra : in 
females, 2 pints of solution (1 to 4000), 
thrice daily, to irrigate vagina, 491, 499 

Opium or belladonna, hypodermically or in 
suppository, to control pain in posterior 
urethritis, at same time discontinuing 
active treatment, and observing strict hy- 
giene and diet, 494 

Prescription for infusion, 193 

Prescriptions for injection for posterior ure- 
thritis, 494 

Quercus alba, injections, useful in females, 
288 

Salol, cubebs, and copaiba, prescription for, 
493 

Silver nitrate, injections (gr. 2 to 4 to the 
ounce), useful in subacute stage ; in 
females, gr. 4 to 60 to the ounce, painted 
over vagina, followed by astringent cotton 
tampon, 247, 499 

Urinating with penis in hot water, to relieve 
ardor urinse, 493 

Warm baths, lasting one-half to two hours, 
useful in early stage, 494 

White's prescription for, 492 

Zinc acetate, injection, gr. 1 to 20 to ounce of 
rose water, 44 

Zinc chloride, injection (gr. 1 to 2 to the 
ounce), occasionally used in second stage, 
132 

Zinc sulphate, weak solution, as an astringent 
injection, 314 

GONOEEHCEA, CHRONIC, 494 

Copper sulphate or silver nitrate, solution as 

an application, after dilatation, to focus of 

inflammation, 495 
Dilatation, if stricture exists, 495 
Prescriptions for, 495 

Pressure and use of cold, often valuable, 495 
Sandalwood oil, to stimulate depraved mucous 

membrane, 299 
Silver nitrate, solution, if discharge persists 

after dilatation; also in posterior urethritis, 

495 
Uvaursi, 330 

GOUT, 499 

Antipyrine, said to have a specific effect, 72 

Baths of sulphides, 314 

Blisters, flying, short distance from inflamed 
joint, every few days, 501 

Chloral, in insomnia, 500 

Chloroform liniment, applied over affected 
part, 138 

Cod-liver oil, 501 

Colchicum, wine of the root, gtt. 20, increas- 
ing by gt. 1 every four hours, till relief or 
symptoms appear toxic, in acute types, 500 



Collodion, not more than 1 or 2 coats ; also 
useful with iodine, 500 

Diet, 500 

Fowler's solution, gtt. 3 in water, a standand 
remedy in subacute and chronic types, 
501 

Iodide of iron, syrup of, and cod-liver oil if 
anaemia is present, 501 

Iodide of potassium, to relieve night pains ; 
also with colchicum, in chronic gout, 500 

Iodine, ointment or tincture, locally applied 
to chronic gouty joints, 501 

Leeches or venesection, contra-indicated, 500 

Lithium carbonate or citrate (gr. 5 to 10 to the 
ounce), locally applied, to dissolve deposit 
around joints, 501 

Morphine, hypodermically, near painful spot 
to relieve acute pain, 500 

Peppermint oil, locally applied, 500 

Potassium bromide, the best remedy for in- 
somnia, 500 

Sodium bicarbonate and linseed oil (1 to 9), 
locally applied to joints, 500 

Stimulants, ether hypodermically, opium ex- 
cept in brain or kidney disturbances ; 
diuretic and alkaline drinks and counter- 
irritation, in retrocedent gout, 501 

Water, distilled or medicinal, in large amounts, 
499 

GRANULAR LIDS. (See 
Conjunctivitis, Granular.) 

GRAVES'S DISEASE. (See 
Exophthalmic Goitre.) 

GRIPING. 

Allspice or ginger, to prevent griping of pur- 
gatives, 55, 184 

GROWTHS, PATHOLOGICAL. 

Caustic potash or soda, occasionally used, to 

destroy, 125 
Chromic acid, as a caustic, to growths on skin 

or mucous membranes, 138 
Lime, as an escharotic on hairy growths, 106 

GUMS, DISEASES OF. 

Burnt alum, useful applied to swollen gums, 
58 

Catechu, as a mouth-wash, for spongy gums, 
125 

Cocaine, locally applied, in soreness and ten- 
derness of gums, 149 

Iodine, solution (gr. 1 to the ounce), locally 
applied, followed by rinsing mouth, when 
gums are retracted, 204 

Myrrh, tincture, locally applied, to spongy or 
tender gums, 244 

H^EMATEMESIS, 504 

Ergot, hamamelis or ipecac, in slow bleeding, 
504 

Ice, cracked, swallowed frequently, accom- 
panied by Monsel's solution gtt. 3 in a half 
tumblerful of water, every fifteen minutes, 
504 

Iron, tincture of chloride, or turpentine, inter- 
nally, if passive, 504 

Lead acetate with morphine or opium, gr. 2 to 
3, in pill, 504 



678 



INDEX OF DISEASES AND REMEDIES. 



Monsel's salt, gr. 2 to 3, in pill, 504 
Silver nitrate, gr. 1-4 in pill, in slow bleed- 
ing, 504 
Tannic acid, gr. 20 to drachm of water ; must 
not be given with Monsel's solution, 504 

HEMATURIA, 506 
Alum, gr. 2 or 3 to water, 1 ounce, injected 

into bladder, if alarming, 506 
Canfphor, gr. 10 to 20, in divided doses, in pill, 

506 
Cannabis indica, useful in some cases, 506 
Ergot, 506 
Erigeron, 506 

Gallic acid, gr. 20, very valuable, 506 
Hamamelis, injected daily into bladder, 506 
Prescription for, 506 
Quinine, if due to malaria, 506 
Rhus aromatica, 290 
Styptic injections, should only be used when 

bleeding is alarming, 506 
Turpentine, 506 

HEMOPTYSIS, 502 

Acetanilide, has been recommended, 43 

Aconite, to prevent pneumonia following, con- 
tra-indicated in exhaustion, 503 

Alum, solution (gr. 20 to the ounce), in fine 
spray, 58 

Chloral and bromides, to allay nervous excite- 
ment, 504 

Ergot, fluid extract, 1 to 1% drachms, inter- 
nally, 503 

Gallic aid, gr. 20 to the ounce of water, when 
ergot is not at hand, 503 

Hamamelis, 189 

Ice or dry cup over bleeding spot, 504 

Ipecac, in small doses, very effective, 209 

Morphine, hypodermically, to allay nervous- 
ness, 503 

Tannic acid, Monsel's solution or alum, used 
in spray, as styptics, prescriptions for, 503 

HEMORRHAGE, 501 

Abdominal transfusion, 368 

Alum, a useful styptic, applied to bleeding 
vessel, 57 

Arnica, 76 

Compress, soaked in antiseptic liquid or filled 
with antiseptic powder, preferable to 
styptics, 501 

Intravenous injections, 364 

Ligation preferable to styptics, when appli- 
cable, 501 

Oil of erigeron, 171 

Packing or astringents, if bleeding point can- 
not be reached by compression or for liga- 
tion, 501 

Tannic acid, 321 

HEMORRHAGE, INTESTINAL, 

504. (See also Hemorrhage.) 
Enemas, styptic, for hemorrhage from rectum 
or colon ; alum (gr. 10 to the ounce), cop- 
per (gr. 5 to the ounce), Monsel's solution 
(dr. 1 to 2 ounces), Monsel's salt (gr. 10 to 
the ounce, or drachm % to water 2 ounces), 
chlorate of potash (gr. 10 to 25 to the 
ounce), and tannic acid (gr. 20 to ounce of 
glycerin and water), 505 



Ergot, 504 

Ice, by mouth, and Monsel's salt, gr. 3, in hard 
pill, every half-hour or oftener, 504 

Ice-water injections in bloody purging of dys- 
entery, 506 

Lead acetate and camphor, in pill, of service 
in some cases, 505 

Monsel's solution not advisable, 214 

Sulphuric acid, gtt. 5 to 10 in water, 505 

Tannic acid, in solution or pill, when Monsel's 
salt is not at hand, 505 

Turpentine, in capsule or emulsion, when 
bleeding is not active, 505 

HEMORRHOIDS, 507 
Aloes, 507 

Carbolic or acetic acid, locally applied, 508 
Cold-water injections in the morning, relieve 
congestion and cause easy evacuation, 507 
Ergot, sometimes useful in bleeding piles, 170 
Gallic acid and opium, ointment, prescription 

for, 508 
Hamamelis, internally or as a lotion or injec- 
tion, 507 
Nitric acid, lightly touched to one or two 

points, 249, 508 
Potassium chlorate, with laudanum, as an in- 
jection, 131 
Quercus alba, as an astringent wash, 288 
Rhubarb root, gr. 10 to 20, chewed before re- 
tiring, to relieve constipation, 507 
Stillingia, prescription for, 311 
Sulphur, to produce soft passages, 317 
Tannic acid, suppositories in bleeding piles, 

321 
Tobacco, contra-indicated, 327 
Wool tampons, 508 

HAY FEVER. 

Arsenic, 79 

Cocaine, with bismuth and morphine, as a 

snuff, 150 
Resorcin, solution 2 per cent., in spray, 289 
Terpine hydrate, in full dose, 322 

HEADACHE, 508 

Belladonna, valuable in young people, 87 

Caffeine, with antipyrine or sodium bromide, 
in nervous headache, 509 

Capsicum plaster, to nape of neck, 115 

Cimicifuga, if due to eye-strain, 140 

Croton chloral, if due to eye-strain or asso- 
ciated with sick stomach, 162 

Cup, to nape of neck, in congestion, 509 

Ergot, if due to congestion, 170 

Eucalyptus, 178 

Gelsemium, if due to nervous troubles or eye- 
strain, 182 

Hydrobromic acid, if due to eye-strain in ner- 
vous women, 99 

Ice-bag, applied to head, or leeches behind 
ears, in severe cases, 509 

Liquor magnesii citratis, in sick headache, 228 

Magnesium carbonate, gr. 5 to 60, in sick head- 
ache due to gastric acidity, 228 

Mustard foot-bath and plaster to nape of neck, 
in congestion, 509 

Nux vomica, gtt. 1 every five or ten minutes 
till 10 drops are taken, in sick headache, 
256 



INDEX OF DISEASES AND KEMEDIES. 



679 



Oxygen water, 226 

Phenacetine, if due to eye-strain or neuralgia, 
275 

Potassium bromide, 95 

Prescriptions for, 509 

Salicylic acid or iodide or acetate of potassium, 
if due to gout. 509 

Sodium bicarbonate, as an antacid in sick 
headache, 89 

Strychnine or nux vomica, if due to eye-strain, 
509 

HEAKT DISEASE, 510 

Aconite or veratrum viride, often useful in 
palpitation and hypertrophy, 513 

Adonidine, often of service when digitalis 
fails, 48, 513 

Ammonia and ether, followed by digitalis and 
alcohol, in heart failure, 513 

Amyl nitrite, in single whiffs, often relieves 
cardiac failure, 65 

Barium chloride, in heart failure, 83. 

Belladonna, when arhythmia is present, 513 

Cactus grandifiorus, useful in valvular disease 
with incompetency, 101 

Camphor, in palpitation, 107 

Cimicifuga, as a tonic in fatty and irritable 
heart when digitalis fails, 140 

Diet and exercise, in fatty degeneration, when 
fat is deposited between muscular fibres, 
514 

Digestive remedies in palpitation due to indi- 
gestion, 513 

Digitalis, to be tried in all heart troubles, ex- 
cept in simple or compensatory hyper- 
trophy, 511 

Hoffmann's anodyne, very useful in palpita- 
tion due to indigestion or tobacco, 190 

Iron, in palpitation due to anaemia, 513 

Nux vomica, in palpitation, as a stimulant, 
513 

Opium, if dyspnoea prevents sleep, 262 

Sparteine, in arhythmia, or palpitation, also 
as a substitute for digitalis, if it fails, 303, 
513 

Strophanthus, may be tried if digitalis fails, 
513 

Veratrine ointment, recommended, applied to 
chest in some cases of palpitation, 513 

HEPATIC ABSCESS, 514 
Active treatment for dysentery, if present, 515 
Ammonium muriate, thought to be of value, 

63 
Aspiration, when pus forms, 515 
Diet, 515 
Quinine, after abscess develops, 515 

HEPATIC CIRRHOSIS. 

Ammonium chloride, 63 
Iodoform, highly recommended, 207 
Potassium iodide, often useful in early stages, 
201 

HEPATITIS, ACUTE, 514 

Aconite, in early stages, 514 

Ammonium muriate, has been recommended, 

69 
Cantharidal blister, small, over right hypo- 

chondrium ; if impractible, use mustard 

plaster, 514 



Hot cloths, over counter-irritant, may relieve 
pain and aid in formation of blister, 514 

Saline purgatives, preceded by calomel, gr. 1, 
in divided doses, if constipation exists, 514 

Sweet spirit of nitre with potassium citrate, or 
diuretic waters, to regulate kidneys, 514 

Veratrum viride, rarely used, 514 

HEPATITIS, CHRONIC AND 
SUBACUTE, 515 

Anti-syphilitic treatment, if due to syphilis, 

515 
Aspiration, frequently repeated, may effect a 

cure, 515 
Nitro-muriatic acid, internally and externally, 

most useful remedy, 515 
Potassium iodide, useful in all cases, 515 

HERNIA. 

Chloroform, inhalations, to relax muscles dur- 
ing reduction, 137 

HICCOUGH, 516 

Belladonna, 87 

Camphor, spirit of, dose 1 drachm, 516 

Capsicum, tincture, gtt. 2 to 3, 516 

Chloral, 129 

Chloroform, 516 

Ether, inhaled or sprayed on epigastrium, 516 

Hoffmann's anodyne, especially valuable, 516 

Musk, gr. 10, given by rectum, valuable in all 

cases, especially in typhoid fever, 516 
Nux vomica, accompanied by mineral acids, if 

due to indigestion, 516 
Oil of amber, gtt. 5 to 10 in capsule, one of the 

best remedies, 516 
Pilocarpine hydrochlorate, hypodermically, if 

due to uraemia, 516 
Valerian, tincture of, dose 1 drachm, 516 

HOARSENESS. 

Sulphides or sulphur water, if due to cold or 
speaking, 317 

HYDROCELE. 

Iodine, injections after evacuation of the sac, 
the best curative remedy, 204 

HYDROCEPHALUS. 

Potassium iodide, to cause absorption of fluids, 

200 

HYSTERIA. 
Calcium bromide, 98 
Hops, as a nervous sedative, 192 
Monobromated camphor, to produce sleep, 109 
Oil of amber, 58 
"Pill of three valerianates," recommended, 

331 
Potassium bromide, 95 
Valerian, 330 
Valerianate of ammonium, 63 

IMPOTENCE. 

Cannabis indica, with strychnine, nux vomica , 
or ergot, if no organic trouble exists, 111 

Cantharis with nux vomica and iron, may 
restore sexual power, if loss is due to 
excess, 113 



680 



INDEX OF DISEASES AND REMEDIES, 



Cold douche to perineum and testicles, in 

atonic types, 351 
Gold, chloride of, and sodium, gr. 1-20, 187 

INCONTINENCE OF URINE, 516 

Antiseptic fluids, to cleanse bladder, in paral- 
ysis, 518 

Arsenic with nux vomica, in weakness of spinal 
centres, prescription for, 517 

Belladonna, if due to vesical spasm, 517 

Buchu with sweet spirit of nitre, valuable in 
some cases, 100 

Cantharides, gtt. 1, with alkaline diuretics, 
thrice daily, in adults, 518 

Catheterization, in retention or paralysis, 518 

Circumcision, if prepuce is redundant, relieves 
some cases, 518 

Diuretic waters, used for years, necessary in 
some cases, 518 

Fowler's solution, gt. % to 1, in chronic types 
due to atony, 517 

Hyoscyamus, if due to irritable bladder, 196 

Rhus aromatica, in incontinence of children, 
due to atony, 290 

Santonin, often valuable when other remedies 
fail, 300 

Sweet spirit of nitre and potassium citrate, if 
urine is dark and concentrated, prescrip- 
tion for, 517 

INDIGESTION, GASTRIC AND 

INTESTINAL, 518 

Alcohol, in adynamic types, 519 

Ammonia, if due to large amounts of lactic 
and butyric acids, 521 

Asafcetida, useful in indigestion associated 
with flatulence in old age, 81 

Bitter tonics, useful in atony, contra-indicated 
in gastric irritation, formulae for, 519 

Bromide of strontium, recommended by See, 
312 

Chiretta, 126 

Diet, 521 

Gold, chloride of, and sodium, when epigastric 
pain is present, 187 

Hydrochloric acid in gastric forms, or com- 
bined with cardamoms, in intestinal indi- 
gestion, 193 

Leptandra, of great value in intestinal types, 
prescription for, 224 

Nitric acid, if sour regurgitation is present, 
after meals, 249, 522 

Nitro-hydrochloric acid, valuable in many 
cases, 251 

Pancreatin with sodium bicarbonate and al- 
kaline mineral waters, in intestinal types, 
521 

Pepsin and hydrochloric acid, if due to defi- 
cient secretion, 520 

Podophyllin or mercury, in lientery, 522 

Prescription for torpid liver of indigestion, 522 

Prescriptions for flatulence of intestinal indi- 
gestion, 522 

Salol, 521 

Salt, in increased amounts, if gastric digestion 
is imperfect, 520 

Serpentaria, as a tonic, 305 

Strychnine, quinine, and nux vomica, useful 
tonics, prescriptions for, 519 



Yellow oxide of mercury, gr. 1-60 or 1-50, in 
trituration, if there is foul belching or ill- 
smelling stools, 240 

INFLAMMATION. 

Cannabis indica, valuable in chronic types 

111 
Cocaine, in acute types, prescription for, 149 
Hop poultice, 192 
Liquor plumbi subacetatis, useful as a topical 

application, 222 
Opium, 261 
Veratrum viride, 333 

INFLUENZA, 522 

Aconite, sweet spirit of nitre, and citrate of 
potassium in combination, valuable in 
early stage, 524 

Antipyrine, phenacetine, and acetanilide 
should only be used in small dose to allay 
pain, 523 

Belladonna, combined with strychnine if there 
be vasomotor paresis, 526 

Bromides, if cough be excessive, 527 

Cannabis indica, often valuable if pushed for 
irritative cough, 527 

Chloral, chloralamid, or sulphonal, for in- 
somnia, 527 

Cold bath, preferable to antipyretics for reduc- 
tion of temperature, 524 

Cup, contra-indicated, 525 

Ergot cannabis indica. with bromides, often 
relieve vertigo, 527 

Salol and phenacetine, valuable in combina- 
tion, to allay irritation and pain, 523 

Steam inhalations, laden with vaporized drugs, 
for cough, 526 

Strychnine, preferable to digitalis, if there be 
tendency to collapse, 526 

INSANITY. (See Mania, Acute.) 

INSOMNIA, 527 

Amylene hydrate, useless if due to pain, 529 

Bath, cold, in cerebral anaemia, hot in nervous 
irritability, 349 

Bromide of potassium with Fowler's solution 
in nervous females, prescription for, 52S 

Cannabis indica. prescription for, 111 

Chloral, useful if not due to pain, prescription 
for, 528 

Chloralamide, gr. 15 to 60, in wine or capsule, 
in nervous insomnia, 529 

Croton chloral, preferable to chloral, if due to 
pain, 162 

Hop pillow, 192 

Hot-water bags to feet and cold to head, if due 
to cerebral hyperemia, 528 

Hyoscine, gr. 1-100 to 1-90 by mouth, or gr. 1-110 
to 1-100 hypodermically, in mania or hys- 
teria, 528 

Hypnal, useful in insomnia due to pain, 197 

Morphine with chloral, if due to pain, pre- 
scription for, 528 

Opium, only to be used in pain, 261 

Paraldehyde, 268 

Potassium bromide, in nervousness and over- 
work, 96 

Somnal, minims 10 to 40, in liquorice and 
water, 529 



INDEX OF DISEASES AND REMEDIES. 



681 



Sulphonal, prescription for, may be given in 

hot water, 529 
Valerian, in nervousness, 330 

INTERMITTENT FEVER, 529 

Alcohol, contra-indicated during chill, 530 

Ansesthetization, has been employed to put off 
paroxysm, 531 

Antipyrine, if fever is excessive, 531 

Arsenic, in intervals between attacks, as an 
antiperiodic, 530 

Calomel, gr. y % to %, every 15 minutes until 1 
grain is taken, 4 or 5 hours before quinine, 
if constipation is present, 530 

Chloroform inhalations, preceded by lauda- 
num, by mouth or rectum, or morphine, gr. 
1-6, with atropine, gr. 1-60, hypodermically 
if death threatens during chill, 530 

Cool drinks and sponging, in fevered stage, 
531 

Digitalis, to relieve internal congestion during 
chill, 531 

Ice-pack, if fever is long-continued and ex- 
cessive, 531 

Ipecac, or zinc sulphate as an emetic, if chill 
follows full meal, 530 

Podophyllin, gr. 1-10 to 1-8, preceding quinine, 
if constipation is present, 530 

Potassium or sodium nitrite, gr. 10, have been 
employed to put off attack, 531 

Quinine, as a prophylactic and antiperiodic, 
530 

INTERTRIGO. (See Chapping.) 

INTESTINAL CATARRH. 

Ammonium chloride, useful in subacute types, 

63 
Chlorate of potassium, injections (gr. 20 to the 

ounce), in acute rectal catarrh, 131 
Iodide of potassium, if ammonium chloride 

fails to relieve, 200 
Leptandra, fluid extract, dose 20 minims to 1 

drachm, 224 
Salol, 298 

INVOLUTION, ANOMALIES OP, 

544 

Cannabis indica, of great value in subinvolu- 
tion, 111 

Curette, in subinvolution due to retention of 
hypertrophic endometrium, 581 

Digitalis, in subinvolution due to sluggish cir- 
culation, 581 

Ergot, quinine, and strychnine, in pill, if due 
to fibroids, 581 

Purgatives, disinfectants, and possibly hot 
water locally applied, if due to inflamma- 
tion, 581 

Removal of placenta, if adherent, 581 

IRITIS, 531 

Atropine, the best local remedy, 531 

Counter-irritation, 356 

Daturine or duboisine, when atropine cannot 

be used, 532 
Iced compress, in early stage of traumatic 

iritis, 531 



Iodide of potassium, alone or with mercury bi- 
chloride, following mercurial impression 
in syphilitics, 532 

Leeches and dry heat or hot fomentations, to 
relieve pain, 531 

Mercury, preferably by inunction, if due to 
syphilis, 532 

Morphine, if pain is severe, 532 

Paracentesis, 532 

Pilocarpine, internally if vitreous becomes 
opaque, also in gonorrhceal types, 532 

Salicylic acid or oil of gaultheria, followed 
later by potassium iodide, in rheumatic 
iritis, 532 

Saline laxatives, during course of disease, fol- 
lowed by iron, after cessation of specific 
treatment, 532 

Turpentine accompanied by potassium iodide, 
in plastic iritis, following secondary syph- 
ilis, 532 

Zollicofier's mixture, useful in chronic types, 
532 

IRRITABILITY. 

Almonds, as a drink in irritability of intestines 
and air-passages, 54 

Cantharis, recommended in irritable bladder 
of women and children, 113 

Cimicifuga, in uterine irritability, 140 

Hops, in vesical irritability, 191 

Petrolatum, as a soothing agent in gastro- 
intestinal types, 273 

Potassium bromide, in irritability of pharynx, 
95 

ITCH. (See Scabies.) 



JAUNDICE. 

Calomel, gr. 1-6, every half-hour till gr. % is 

taken, if due to cold, 237 
Carbolic acid, gr. 10, with water and glycerin, 

each 2 drachms, locally applied in itching 

of jaundice, 118 
Citric acid, 147 

Hydrastis, useful in subacute types, 193 
Iodoform, highly recommended, 207 
Leptandra fluid extract, dose 30 minims to 1 

drachm, 224 
Manganese sulphate, may be tried in malarial 

types, 229 
Pilocarpine, useful unless due to malignant 

disease, 282 

Salol, said to be of value, 298 

* 

JOINTS, ENLARGED. 

Ammoniac plaster, a useful stimulant, 64 

KELOID. 

Ichthyol ointment, 198 

KERATITIS, INTERSTITIAL, 532 

Antiseptic lotions, in marked ciliary conges- 
tion, 533 
Anti-syphilitic treatment, if due to syphilis, 533 
! Atropine, in ciliary congestion, to prevent 
iritis, 533 
Creolin, 162 
! Leeches, to temple to relieve pain, if patient is 

not too young for bleeding, 533 
| Thymol iodide, as a dusting- powder, 326 



682 



INDEX OF DISEASES AND REMEDIES 



KERATITIS, PHLYCTENULAR, 

533 

Atropine, to relieve pain, 533 

Boric acid, solution, to relieve congestion, 533 

Cocaine, not advisable in photophobia, 533 

Cold-water douche on closed eyelid, to relieve 
photophobia, 533 

Dark glasses, to protect eyes, 533 

Tonics and alteratives, with strict hygienic 
and regulated diet, associated with local 
treatment, 533 

Yellow oxide of mercury ointment, or calomel 
as a dusting powder to hasten cicatriza- 
tion, contra-indicated if iodine is being 
given, 533 

KERATITIS, SUPPURATING, 533 

Antiseptic lotions, to limit sloughing, 534 

Cautery, actual, best means of preventing per- 
foration, 534 

Curetting floor of ulcer, if perforation threat- 
ens, 534 

Eserine or atropine, instilled into eye, to limit 
sloughing, 534 

Hot compresses, 534 

Massage of cornea and introduction of yellow 
oxide ointment, to remove scars of ulcers, 
534 

Pressure-bandage, if perforation threatens, 534 

Silver nitrate (gr. 10 to 20 to the ounce) , touched 
to margins of ulcer, if perforation threat- 
ens, 534 

LACHRYMAL ABSCESS, 535 

Blue pyoktanin (1 to 1000), injected through 
external opening if there is purulent dis- 
charge, 535 

Division of canaliculi and washing out sac 
with antiseptic fluids, and insertion of 
probes into ducts after inflammation sub- 
sides, to restore patulency, 535 

Hot compresses composed of lead-water and 
laudanum, to relieve pain, 535 

Puncture of abscess, if rupture threatens, 535 

LARYNGISMUS STRIDULUS. 

Amyl nitrite, 65 
Belladonna, 87 
Gelsemium, 183 

LARYNGITIS, ACUTE, 535 

Abstinence from talking, with bland and un- 

irritating but nutritious diet during attack, | 

536 
Aconite, with a diaphoretic to control fever 

536 
Alkaline and astringent sprays, followed by j 

insufflations of anodyne and astringent 

powders, 536 
Bromide of sodium or potassium, with small 

doses of potassium cyanide, in excessive j 

cough, 536 
Bromides useful in full doses, 60 to 120 grains a 

day, 96 
Calomel, small and repeated doses, followed 

by saline purges along with hot mustard 

foot-bath and demulcent drinks, 536 
Dover's powder, if necessary, to give rest, 208 
Iodol, insufflations, in tubercular types, 536 
Lozenges, preferable to gargles, 536 



Oil of amber and olive oil, half and half, well 
rubbed into the skin of the neck and 
chest, 536 

Silver nitrate, 247 

Steam inhalations, charged with benzoin, cam- 
phor, or cubebs, 536 

Tonics, woollen underwear, fresh air, and 
change of climate during convalescence, 
536 

LARYNGITIS, CHRONIC, 538 

Formula for powder, as a protective to raw or 
ulcerated surfaces, 540 

Silver nitrate, strong solution, pure salt or 
mitigated stick, touched to indolent or 
granulating inter-arytenoid fissures, 538 

Training of voice, removal of nasal obstruc- 
tions, and relief of irritation, necessary for 
cure in some cases, 540 

Vapor and powder inhalations and other 
measures, same as for subacute types, 540 

LARYNGITIS, SUBACUTE, 536 

Benzoin, camphor, fluid extract of cubebs, or 
tar, as inhalations, 537 

Insufflation powders— zinc sulphate and milk 
sugar, equal parts, reduced ; tannic acid 
reduced to 1-4 or 1-5 with iodoform, useful 
in abraded or ulcerated surfaces, bismuth 
subnitrate or subcarbonate and morphine 
may be added if indicated ; lead acetate, 
gr. 10 to 20 to the % ounce, with a little 
morphine acetate, 537 

Lithia water, in laryngeal thickening, 537 

Potassium iodide, in small doses, long contin- 
ued, with or without arsenic, in laryngeal 
thickening, 538 

Remedies for acute types, usually sufficient to 
effect cure, 537 

Tonics, generous diet, exercise, and use of 
woollen underwear, to prevent return, or 
development of chronic type, 538 

Turkish baths and friction of skin, in rheu- 
matic or gouty cases, 538 

Zinc sulphate, ferric alum, tannic acid, or weak 
bichloride solution in spray, 538 

LEUCORRHOUA, 541 

Alum, gr. 10 to 20 to the ounce, as a vaginal 

wash, 5S 
Ammonio-ferric alum, gr. 2 to 5, in atonic 

types, 197 
Belladonna, gr. 1 to 2, with tannic acid, gr. 6 to 

8, applied on cotton, in disease of uterine 

cervix, 86 
Cantharidal collodion, applied over groins to 

produce blister, in catarrh of Fallopian 

tubes or ovarian irritation, 542 
Goodell's prescription for, 542 
Hot sitz-bath, or vaginal injections of hot 

water, if due to uterine congestion, 360 
Hydrastis injections, if due to relaxed vagina, 

193 
Iron, with tonics, if due to excessive lactation 

or exhausting life, prescriptions for, 541 
Myrrh, if due to uterine trouble, 244 
Potassium permanganate (drachm 3-2 to water 

1 pint), as an injection, if discharge is 

foetid, 505 
Prescription for injection, 542 



INDEX OF DISEASES AND REMEDIES. 



683 



Ringer's prescription for wash, 542 

Tampon, saturated with iodoform and tannic 
acid, equal parts, sometimes of service, 542 

White-oak bark (ounce 1 to water 1 pint), or 
tannic acid and glycerin (ounce 1 to 2 
quarts of water), as an injection, 54 

LICHEN. 

Arsenic, usually cures, 78 

Bath of sulphides, often beneficial, 314 

Cantharides, 113 

LID ABSCESS, 543 

Treatment, same as for other abscesses, 543 

LITH^MIA. (See Gout.) 

LOCOMOTOR ATAXIA. 

Acetanilide, 42 
Antipyrine, 73 
Potassium bromide, to prevent laryngeal 

crises, 96 
Suspension, 368 

LUMBAGO, 543 

Acupuncture, often relieves, especially if pain 

is bilateral, 543 
Antifebrin ; dose, gr. 4 to 8, 543 
Antipyrine ; dose, gr. 10 to 20, 543 
Chloroform liniment, 138 
Cod-liver oil, 153 
Foot bath and Dover's powder, before retiring, 

often relieves, 543 
Ice-bag or ether spray to loins, if hot applica- 
tions fail, 543 
Ironing back with laundry iron, skin being 

protected by cloth or paper, very efficient, 

543 
Monobromated camphor, with other drugs, 

very useful, 109 
Mustard or capsicum plaster or ' blister, over 

painful spot, may relieve, 543 
Phenacetine and salol, of each 5 grains, 543 
Potassium iodide or salicylic acid, if recovery 

is slow, 543 
Poultice, a large hot, to lumbar region, useful 

in obstinate cases, 543 
Turpentine, gtt. 20, said to be useful, 329 

LUPUS. 

Acid nitrate of mercury, 240 
Europhen, in ointment or powder, 179 
Ichthyol ointment, 198 
Iodine, as a paint, to retard spread, 204 

MALARIAL FEVER. 

(See Intermittent and Remittent Fevers. \ 

Antipyrine, 73 

Arsenic, as a cure and prophylactic, 78 

Eucalyptus, instead of quinine when it cannot 

be borne, 178 
Gelsemium, of doubtful value, 182 
Gentian, in malaria associated with dyspepsia, 

183 
Hydrastis, said to be anti-malarial, 193 
Pilocarpine, may be used to abort, 282 
Quinine, the best remedy as a prophylactic 

and a cure, 142 



MANIA, ACUTE, 544 

Anaesthetics, or apomorphine in emetic dose, 
to relax muscular system, if patient is very 
violent, so that other remedies may be ad- 
ministered, 544 

Bromide of potassium, as a soporific, 96 

Cannabis indica with large dose of bromides, 
particularly serviceable, 544 

Chloral, in full doses, if kidneys are healthy, 
544 

Cimicifuga, fluid extract, gtt. 20 to 30, thrice 
daily, in cases occurring after confinement 
not due to permanent causes, 544 

Cold douche to head while body is immersed 
in hot water, often of service, 544 

Hyoscine hydrobromate, gr. 1-100, when neces- 
sary to quiet patient rapidly, 544 

Morphine, in full dose, may be required to 
quiet patient, 544 

MARASMUS. 

Cod-liver oil inunctions, one of the best 
remedies, 152 

MASTITIS. (See Breast, Inflamed.) 

MELANCHOLIA, 544 

Nitro-muriaticacid, gtt. 5, in water after meals, 
if associated with oxaluria, 544 

Phosphorus, useful in some cases due to over- 
work, 278 

MENINGITIS, ACUTE, 544 

Aconite or veratrum viride, in early stages to 
depress circulation, 545 

Alcohol, given with food in second stage, if 
there be asthenia, 545 

Belladonna, often useful, especially when 
opium and calomel are contra-indicated, 
545 

Blister to nape of neck, in early stage, to pre- 
vent effusion ; also in comatose state, 545 

Bromides and chloral, best agents to allay 
nervous symptoms, 545 

Calomel, gr. %, with opium, gr. %, every half- 
hour, in early stage, until effect is mani- 
fested ; the deodorized tincture, gtt. 2 to 5, 
every two hours, or less, preferable to 
powder of opium, in some cases, 545 

Ergot, in stage of exudation, 545 

Ice-bag to head, in early stage, 545 

Leeches to nape of neck, in early stage, 545 

Milk diet, in second stage, 545 

Opium, useful in second stage, 545 

Quinine, contra-indicated in acute stage, 545 

Venesection in early stage of sthenic cases, if 
aconite or veratrum viride are not at hand , 
545 

MENINGITIS, CHRONIC. 

Phosphorus, 278 

MENOPAUSE. 

Bromide of potassium, in nervous disorders, 
96 

Cannabis indica, alone or with aloes and iron, 
if anaemia or constipation exist, in head- 
aches of the menopause, 111 



684 



INDEX OF DISEASES AND REMEDIES. 



Eau de Cologne, saturated with camphor, lo- 
cally applied in headache or drowsiness, 
108 

Valerianate of ammonium, in nervous disor- 
ders, 63 

MENORRHAGIA AND 
METRORRHAGIA, 502 

Bromide of potassium or sodium, gr. 10, once 

or twice daily, if bleeding is irregular, 96, 

502 
Cannabis indica, recommended, 502 
Cinnamon oil, drachm %, when erigeron is not 

at hand, in oozing flow, 502 
Dry cups, over sacrum, if due to congestion, 

502 
Ergot, fluid extract, gtt. 10 to 60, best remedy 

in active bleeding, 502 
Erigeron, oil of, minims 3 to 5, in capsule or 

emulsion, the best remedy for oozing, 502 
Hamamelis, distilled extract, drachm 1, thrice 

daily, in irregular bleeding, 502 
Monsel's solution (50 per cent.) full strength, 

locally applied, if due to polypus, 214 
Rhus aromatica, highly recommended in men- 

orrhagia, 290 
Rue, in atonic menorrhagia, 292 
Savine, oil of, gtt. 5 to 10, in capsule or emul- 
sion, every three or four hours, as a tonic 

in menorrhagia, 301 
Turpentine, often of value, 329 

MIGRAINE, 555 

Amyl nitrite, 65 

Bromide of potassium, with caffeine, almost a 

specific, if due to eye-strain, 96 
Cannabis indica, tincture, gtt. 20, hourly, or 

extract, gr. % to %, every two hours, best 

treatment, 555 
Croton chloral, very efficient, especially if fifth 

nerve is involved, 162 
Gelsemium, with cannabis indica, to abort, 

182, 555 
Salicylic acid, of great service, in rheumatic 

types, 295 

MILK DEFICIENCY, 583 

Electricity, 584 

Treatment for intercurrent affection, if due to 
that cause, 584 

MORPHIOMANIA. (See Poisoning— 
From Opium, Chronic.) 
Bromide of potassium, 96 
Phosphorus, of service in sequelae of morphio- 
mania, 278 

MUCOUS MEMBRANES, 
DISEASES OF. 

Acacia, as a mucilaginous drink in irritation 
and inflammation of upper air-passages, 
39 

Bismuth, as an astringent, to inflamed mem- 
branes, 90 

Flaxseed, as a soothing demulcent, 180 

Glycerole of aloes, locally applied to fissures, 
valuable, 56 

Opium, suppositories, gr. %, useful in rectal 
inflammation, if not an acute catarrh, 261 



Pareira, useful in chronic genito-urinary in- 
flammation, 269 

Terebene, useful in. subacute and chronic 
genito-urinary inflammation, instead of 
sandalwood or copaiba, 323 

Zinc sulphate, weak solution, as an astringent, 
314 

MUSCLE VOLITANTES, 546 

Alteratives and correction of anomalies of re- 
fraction, 546 

MUSCULAR STIFFNESS. 

Hot laundry iron passed over part, skin being 
protected by layers of paper or cloth, often 
relieves, 360 

MYALGIA, 546 

Ammonium chloride, if due to cold or bruises, 
546 

Camphor liniment,108 

Chloroform liniment, 546 

Cimicifuga, fluid extract, gtt. 20 to 1 drachm, 
546 

Clove oil, added to liniment, as a counter- 
irritant, 148 

Iodide of potassium or salicylates, if due to 
rheumatism, 546 

Iodine ointment, pure, or diluted with lard, 
546 

Massage or good rubbing, very necessary, 546 

Potassium acetate or citrate, gr. 20, may be 
tried, 546 

Poultices, hot as can be borne, 546 

Prescription for liniment, 546 

NASAL CATARRH, ATROPHIC, 547 

Dobell's solution, as a cleansing wash ; car- 
bolic acid may be increased, or thymol 
and eucalyptus substituted for it, to relieve 
odor, 547 

Galvano-cautery, or strong silver nitrate solu- 
tion, if ulcerations are present, 548 

Hydrogen peroxide, 547 

Iodine and glycerin (gr. 6 to 8 to the ounce), 
with potassium iodide sufficient to make 
solution, valuable, locally applied, 548 

Listerine, may be added to Dobell's solution, 
to relieve odor, 547 

Potassium iodide, internally, tonics and stimu- 
lants to mucous membrane and attention 
to activity of skin, 548 

Potassium permanganate, useful; painful if 
sensation is not entirely lost, 547 

Removal of necrosed bone, 548 

Silver nitrate and starch (gr. 1 to 10 to drachms 
2%), as an insufflation powder, or solution 
(gr. 1 to 10 to the ounce), better, in some 
cases, locally applied, 548 

NASAL CATARRH, CHRONIC, 548 

Ferric alum (gr. 5 to the ounce), useful, in 
spray, in later stage, 552 

Galvano-cautery or snare, to remove hypertro- 
phic tissue remaining after acute stage, 552 

Hydrastis, dilute solution, or distilled extract 
of hamamehs and water, equal parts, use- 
ful in spray, in acute stage, 552 

Iodine and glycerin (gr. 6 to 8 to the ounce), 
with potassium iodide, sufficient to make 
solution, locally applied, 515 



INDEX OF DISEASES AND REMEDIES. 



685 



Prescription for alkaline wash, 547 
Remedies for coryza, useful, instituted for a 
few days, 433 

NAUSEA. (See Vomiting.) 
Hoffmann's anodyne, when due to excessive 

use of tobacco, 190 
Hydrocyanic acid, dilute, gtt. 20, in water, 

often useful, 195 
Lime-water, 106 

NEPHRITIS. (See Bpjght's Disease.) 

NERVOUSNESS. 

Camphor, as a sedative, 107 

Hops, as a sedative, 192 

Musk, useful in nervous excitement and col- 
lapse ; only to he used through crisis, 242 

Phosphorus, in nervous debility and exhaus- 
tion, 278 

"Pill of three valerianates," highly recom- 
mended, 331 

Rest-cure very useful where nervousness is due 
to exhaustion, 366 

Strychnine, in functional nervous atony or de- 
pression, 255 

Sumbul, prescription for, 319 

Sweet spirit of nitre, in nervous excitement of 
fever and other nervous states of infancy, 
320 

Valerian, alone or with other drugs, 330 

NEURALGIA, 552 

Acetanilide, useful, especially with monobro- 
mated camphor, 42 

Aconite ointment (gr. 2 to the drachm) , or 
oleate of aconitine (gr. 2 to sweet oil 100), 
useful applied over painful spot, if limited 
in area ; if not, contra-indicated, 47, 554 

Acupuncture, nerve-stretching, or neurectomy 
necessary in some cases, 554 

Amyl nitrite, inhalations, when due to anae- 
mia, 554 

Antipyrine, gr. 5 to 20, very useful, 553 

Belladonna, 87 

Bromide of potassium with caffeine, almost a 
specific, 554 

Camphor liniment, locally applied, to relieve 
pain, 108 

Chloralamide, 130 

Chloroform liniment, as a local anaesthetic, 140 

Cimicifuga, especially useful in ovarian types, 
138 

Cod-liver oil, 153 

Croton chloral, gr. 5 to 20, in 5- grain pills, often 
effective in brow neuralgia, 554 

Freezing parts with ether or rhigolene spray, or 
by small package of ice and salt, successful 
if nerve is superficial, 554 

Hydrocyanic acid, useful in intestinal neu- 
ralgia, 195 

Iodide of potassium, may be tried in rheu- 
matic neuralgia, 200 

Iron and arsenic, in anaemia, often necessary 
to associate with them bitter tonics and 
cod-liver oil, 553 

Kataphoresis, 365, 554 

Morphine, gr. 1-5 to 1-4, injected into painful 
spot, if localized ; not advisable in chronic 
cases, 554 



Muriate of ammonium, useful in ovarian tvpes, 
63 

Mustard plaster, as a counter-irritant, 243 

Nux vomica or strychnine, if nerve is depressed 
by anaemia, 553 

Peppermint oil, locally applied on cloth over 
painful spot, 270 

Phenacetine, gr. 3 to 8, very useful, 554 

Phosphorus, if due to nervous exhaustion, 553 

Prescription for, 275 

Prescriptions containing antipyrine with bro- 
mides and caffeine, 554 

Quinine, if due to malaria, 553 

Eest-cure very useful in exhausted patients, 
366 

Specific remedies, if due to scrofulosis or syph- 
ilis, 553 

Turkish bath, may relieve, if due to rheu- 
matism or gout, 261 

Veratrine ointment, locally applied over neu- 
ralgic nerve, 337 

NIGHT-SCREAMING. 

Bromide of potassium, 96 

NIGHT-SWEATS. 

Acetic acid, as a lotion, diluted one-half. 44 

Agaricin, of doubtful value, 48 

Alum dissolved in water or alcohol, efficient 
application for sponging, 57 

Belladonna, best remedy, 86 

Camphoric acid, the best of all remedies, 109 

Ergot, 170 

Gallic acid, 181 

Pilocarpine, gr. 1-20 hypodermically, two hours 
before sweat, often useful, even when atro- 
pine fails, 282 

Sulphuric acid, with belladonna or morphine, 
often useful, 318 

Zinc oxide, prescription for, 266 

NIPPLES, SORE, 555 

Benzoin, tincture locally applied, 555 

Boric acid (gr. 20 to the ounce), or mucilage of 
acacia, applied after nursing, nipple being- 
dried beforehand, 555 

Breast-pump or nipple shield may be necessary 
to effect cure, 555 

Cocaine (gr. 4 to the ounce), applied and 
washed off before nursing, if breast is very 
painful, 555 

Silver nitrate stick touched to fissure, if deep 
and slow to heal, 555 

Tannin, glycerite of, locally applied, 555 

NYMPHOMANIA. 

Bromide of potassium, of great service, 96 

OBESITY, 555 

Acetic acid, harmful, 44 

Cold bath, 558 

Diet, 556 

Laxative fruits and purges, to regulate bowels, 

558 
Massage, passive movements, absolute 

skimmed-milk diet, and electricity, if 

exercise is impracticable, 558 
Potassium permanganate, 272 



686 



INDEX OF DISEASES AND REMEDIES. 



Saline purges, if liquid taken in drink is not 

rapidly eliminated, 558 
Turkish bath, 558 

OPHTHALMIA. (See Conjunctivitis.) 

OPIUM HABIT. (See Poisoning feom 
Opium, Chronic.) 

ORCHITIS. (See Epididymitis.) 

OSTEOMALACIA. 

Phosphorus, 278 

OTORRHCEA. 

Creolin, solution (1 to 500), used with syringe, 
162 

OVARIAN TUMOR. 
Iodine, 204 

OZJENA. 
Prescription for insufflation powder, 2.>4 

PARALYSIS AGITANS. 

Cannabis indica, to quiet tremors, 111 
Chloral, of great service, 128 

PARASITES. 

Bichloride of mercury (gr. 2 to water oz. 1), ap- 
plied thrice daily in parasitic skin diseases, 
235 

Chrysarobin, gr. 1-8, internally, or the oint- 
ment, with benzoated lard (1 to 4 or 5), 
locally applied, in parasitic skin diseases; 
must not be used on face, 139 

Mercurial ointment, useful to destroy pedicu- 
lus pubis or other parasites, 239 

Volatile or fixed oils, useful to destroy, 239 

PARTURITION. 

Castor oil. to relieve constipation, 123 
Chloral, if rigidity of os exists, 129 
Cimicifuga, 140 
Quinine, as a stimulant to uterus, 142 



PEMPHIGUS. 



Arsenic, 78 



PERICARDITIS, 558 

Aconite, to allay inflammation and quiet heart, 
47 

Alcohol, digitalis, or caffeine, if heart shows 
signs of failure, 559 

Aspiration, gradual, if exudation endangers 
life, 559 

Blister, over prsecordium, often useful, 559 

Calomel, gr. %, with opium, hourly, to prevent 
exudation, 559 

Iodide of potassium, to aid in absorption of 
fluid, 200 

Jalap, compound powder of, gr. 20 ; or elate- 
rium, gr. 1-6 ; or saline purgative, before 
breakfast, useful in sthenic cases, to re- 
move effusion, 555 

Leeches, 5 to 10, over praecordium, accompa- 
nied by large dose of veratrum viride, in 
early stage of sthenic cases, 558 

Opium, to allay inflammation. 261 



PERITONITIS, ACUTE, 559 

Aconite, preferable to veratrum viride, to de- 
press circulation, 559 

Belladonna and opium, by mouth ; if impossi- 
ble, by rectum, to relieve vomiting and 
pain ; also useful in obstinate constipation 
due to intestinal paralysis, 559 

Leeches, 10 to 30, or mustard plaster to abdo- 
men, accompanied by opium and bella- 
donna, given as above, to relieve pain and 
vomiting in early stage, 559 

Mercury, useful only in severe acute forms 
due to traumatism or other causes, 560 

Pancreatinized milk, frequently given during 
attack, also enjoining absolute rest, 560 

Saline treatment, 561 

Turpentine stupes, or turpentine, drachm 1 ; 
milk of asafcetida, oz. 3 ; and water, oz. 4, 
as an enema, if tympanites is present, 561 

Venesection, valuable in early stage, if case is 
sthenic, 371 

Veratrum viride, inferior to aconite, in early 
stage, 559 

PERNICIOUS MALARIAL 
FEVER, 563 

Quinine, large doses, in solution, by mouth, 
rectum, or hypodermically, 563 

PHARYNGITIS. 

Cocaine, gives temporary relief; after-effects 
bad, 149 

Cubebs, troches of, used in chronic types, 163 

Monsel's solution, pure or diluted one-half 
with glycerin, applied on pledget of cot- 
ton or camel's-hair brush, 214 

Peroxide of hydrogen, 267 ■ 

Silver nitrate solution, in varying strength, 
locally applied, 247 

PHTHISIS. (See Tuberculosis.) 

PLEURITIS, or PLEURISY, 564 

Aconite or veratrum viride, preferable to vene- 
section, in early stage, 564 

Aspiration, when hydragogue purges fail to 
remove effusion, 565 

Blisters, useful in early stage; also during stage 
of effusion, 564, 565 

Calomel, in sthenic cases, to prevent exudation, 
564 

Cantharidal blister, two inches below axilla, 
aids absorption of effusion, 355 

Cotton jacket, 564 

Digitalis or alcohol, if pulse weakens in second 
stage, 565 

Dry cup, contra-indicated over diseased area, 
may be employed over back, 564 

Elaterium or jalap, useful to remove effusion, 
565 

Gelsemium, 182 

Ice-poultice or jacket, used with success in 
sthenic cases, 346 

Iodide of potassium, used in chronic stage, to 
aid absorption, 200 

Iodine, locally applied, to abort, and aid ab- 
sorption of fluid, 204 

Poultices, 564 

Saline purges, in second stage, to remove effu- 
sion, 564 



INDEX OF DISEASES AND KEMEDIES 



687 



Strapping chest, if respiratory movements are 

very painful, 564 
Wet cups, useful in early stage, over inflamed 

spot, 564 

PLEURODYNIA. (See Neukalgia.) 
PNEUMONIA, 565 

Aconite, preferable to veratrum viride, in early 
stage, in children, 567 

Alcohol, inferior to digitalis, as a cardiac 
stimulant in the second stage, 572 

Antimony, should only be used in sthenic cases, 
573 

Antipyrine, of great value if fever is excessive, 
72 

Blisters applied to one side of congested spot, 
in first stage : immediately over spot in 
stage of resolution, 570 

Cardiac stimulants, if secondary attack is su- 
perimposed on first, 574 

Cayenne pepper, a valuable counter-irritant, 
570 

Chloral, not advisable, 569 

Cotton jacket, 575 

Cups, dry and wet, in first stage ; also in secon- 
dary attack superimposed on first, 569 

Digitalis, tincture, gtt. 5, every four hours, ac- 
companied by strychnine, gr. 1-20, care- 
fully watched, in second stage, 570 

Ethyl iodide, causes resolution, 177 

Expectorants must be stopped, if secondary 
attack is superimposed on first, 574 

Gelsemium, not advisable, 569 

Ice-poultice or jacket highly recommended in 
first stage of sthenic cases, 346, 569 

Leeching, bleeding, cupping or cardiac seda- 
tives, in sthenic cases, if secondary attack 
is superimposed on first, 574 

Mustard plaster, to chest in first stage ; to feet 
in secondary attack superimposed on first, 
570, 574 

Oxygen inhalations, if asphyxia threatens, 574 

Phosphorus, 278 

Pilocarpine, hypodermically, only to be used 
in earliest stage, 569 

Poultices, useful in second and third stages, 574 

Prescriptions, containing ammonium chloride, 
to loosen cough of second stage, 573 

Quinine, gr. 2, thrice daily, in suppository, in 
lobar pneumonia of children, 143 

Strychnine as a respiratory and circulating 
stimulant in second stage, 572 

Turpentine stupe, in first stage ; also in second- 
ary attack superimposed on first, 570, 574 

Venesection, in early stage of sthenic cases, 
cardiac depressants preferable, 370 

Veratrum viride, preferable to aconite, in early 
stage, in adults, 567 

POISONING FROM 

Acetanilide. 

Supportive measures, stimulants, external heat, 
belladonna to maintain blood pressure, 
strychnine to counteract respiratory fail- 
ure, and oxygen inhalations to overcome 
cyanosis, 42. 

Acetate of Zinc. 

Treatment same as for gastro-enteritis, 489 



Acetic Acid. 

Large amounts of milk, alkaline liquids, and 
general treatment for gastro-enteritis, 44 

Aconite. 

Keep patient in prone position with feet 
higher than head. Hot applications ; 
emetics contra-indicated ; evacuate stom- 
ach by siphon or stomach-pump. Ether 
hypodermically, followed by alcohol and 
this by digitalis. Artificial respiration and 
amyl nitrite, a few whiffs, no more, if 
heart fails, 46 

Alcohol, Acute. 

External heat, digitalis and strychnine hy- 
podermically, in coma, if heart fails. Bel- 
ladonna, if skin is relaxed and clammy, 
and counter-irritation to nape of neck, for 
brain symptoms. After-treatment, ammo- 
nia, spices, spirit of Mindererus ; emol- 
lients in gastritis. Ice, aconite, or ipecac 
in minute dose, and counter-irritation for 
vomiting. Jalap, gr. 40, elaterium, gr. 1-6, 
or calomel and salines, as purgatives, 50 

Alcohol, Chronic. 

Withdrawal of drug, at once or gradually. 
Highly seasoned broths, predigested foods, 
and morphine or coca, in small dose, if 
weakness is marked. Capsicum prescrip- 
tions (pages 51, 114), 51 

Antimony. 

Large doses of tannic acid, external heat, alco- 
hol, digitalis, and opium hypodermically, 
if respiration is not too feeble. Prone posi- 
tion, the patient vomiting into towels. 
Stomach-pump, if vomiting is absent, 68 

Antipyrine. 

Maintain bodily heat, stimulants, atropine, and 
oxygen inhalations, if cyanosis is alarm- 
ing, 72 

Arsenic, Acute and Chronic. 

Stomach-pump, external heat, stimulants, and 
the chemical antidote, hydrated sesquiox- 
ide of iron and magnesia. Magnesia also 
useful by itself. Opium should follow anti- 
dote, to allay pain, also large draughts of 
water to flush kidneys and dilute poison. 
For chronic poisoning, iodide of potassium, 
tonics, electricity, and out-of-door life, 80 

Carbolic Acid. 

Soluble sulphates, as Epsom or Glauber salts, 
warm mucilaginous drinks, hot applica- 
tions to extremities, digitalis, strychnine, 
and counter-irritation over abdomen. 
Emetics and stomach-pump should be used 
if possible, 116 

Carbon Bisulphide. 

Potassium bromide and chloral, if convulsive 
disorders exist, and circulatory stimulants 
if heart failure threatens, 120 



688 



INDEX OF DISEASES AND REMEDIES. 



Chloral. 

External heat, emetics in early and stomach- 
pump in later stages. Strychnine or atro- 
pine to stimulate respiration. Digitalis 
preceded hy ether, ammonia, "brandy, or 
whiskey: Prone position, feet being ele- 
vated, 128 

Chloroform. 

Artificial respiration, ether and hot brandy 
hypodermically. Poles of battery with 
rapidly interrupted current swept over 
hody; not over diaphragm or phrenic 
nerve. Place patient with head downward. 
Atropine, strychnine, and digitalis to 
stimulate heart and respiration, 135 

Colchieum. 

Tannic acid, emetics, and stomach-pump. Opi- 
um to relieve pain and oils to soothe in- 
flamed mucous membranes. Atropine and 
stimulants if collapse comes on, 155 

Conium. 

Emetics or stomach-pump, strychnine as a 
nervous and respiratory stimulant, external 
heat and cardiac stimulants, if circulation 
fails, 157 

Copper. 

Yellow prussiate of potassium, sweet oil, white 
of egg; followed instantly hy emetics or 
stomach-pump. If emesis or purgation is 
present emetics are contra-indicated, in- 
stead, mustard plaster over abdomen and 
opium internally are to be employed, 159 

Corrosive Sublimate. 

Large amounts of white of egg, followed by 
stomach-pump, external heat, stimulants, 
234 

Croton Oil. 

Treatment same as for gastro-enteritis, 489 

Digitalis. 

Tannic acid as a chemical antidote, emetics or 
stomach-pump, external heat to abdomen 
and aconite as a physiological antidote. 
Maintain horizontal position, 166 

Elaterium. 

Treatment same as for gastro-enteritis, 487 

Ether. 

Artificial respiration, lowering head if face is 
pale ; strychnine, atropine, and digitalis 
hypodermically, or intravenous injection 
of ammonia to stimulate heart and respira- 
tion ; frictions and hot applications ; ether 
dashed on chest and abdomen, 174 

Gelsemium. 

Emeticsand stomach-pump, digitalis, atropine, 
and ammonia as cardiac stimulants ; exter- 
nal heat, strychnine, and atropine for re- 
spiratory centre, 183 



Iodine. 

Emetics or stomach-pump, large amounts of 
starch, hot applications, and hypodermic 
injections of alcohol, ammonia, atropine, 
digitalis, or strychnine, 202 

Lead, Acute. 
Epsom or Glauber salts, in large amounts; 
emetics or stomach-pump, if vomiting pro- 
duced by the drug has not cleared stomach 
of all poison. Hot applications and opium 
to relieve pain, 219 

Lead, Chronic. 

Jalap and calomel with opium or alum, gr. 
2, in full dose, valuable in lead colic. 
Blister to hack of neck, revulsives and 
pilocarpine in cerebral inflammation. 
Iodide of potassium to eliminate lead. 
Strychnine in progressive paralysis. Elec- 
tricity and baths of sulphuret of potas- 
sium, to restore lost function, 221 

Mineral Acids. 

Alkalies, such as magnesium, lime, whitewash, 
and soap as antidotes ; white of egg, ex- 
ternal heat, oils and opium, to relieve 
irritation. 



Monsel's Solution. 



Soap, 214 



Nitrate of Silver, Acute. 

Common salt as the chemical antidote, opium 
and oils to allay irritation, also large 
amounts of milk and soap and water, 245 

Nitrate of Silver, Chronic. 

Iodide of potassium, to aid in eliminating poi- 
son, 246 

Nux Vomica and Alkaloids. 

Inhalations of amyl nitrite, to prevent convul- 
sive tendencies, at the same time use stom- 
ach-pump. Tannic acid followed by phys- 
iological antidotes, potassium bromide, gr. 
60, with chloral, gr. 20. If convulsions 
prevent swallowing, chloroform patient 
carefully and give antidotes by rectum in 
starch-water. Amyl nitrite, hypodermi- 
cally, if relaxation does not occur, 254 

Opium, Acute. 

Emetics or stomach-pump, tannic acid, black 
coffee, electricity, and other measures to 
keep patient awake. Atropine or strych- 
nine, hypodermically, if respiration fails. 
Alcohol, ammonia, and external heat. 
Artificial respiration may be necessary, 258 

Opium, Chronic. 

Decrease a sixth or fourth of customary amount 
each twenty-four hours. Cocaine not ad- 
visable as a substitute, as the cocaine-habit 
may be established. Digitalis if heart fails, 
260 

Phosphorus. 

Sulphate of copper as the chemical antidote, 
acts as an emetic if given in excess, 277 



INDEX OF DISEASES AND REMEDIES. 



689 



Physostigma. 

Atropine as a physiological antidote, external 
heat, and cardiac and respiratory stimu- 
lants, 280 

Scammony. 

Treatment same as for gastro-enteritis, 489 
Strychnine. (See Nux Vomica.) 
Tobacco. 
Strychnine, cardiac stimulants, external heat, 
and atropine, 327 

Veratrurn Viride. 

Prone position, head higher than feet; atropine, 
strychnine, external heat, and cardiac 
stimulants, 333 

POST-PAETUM H^EMOREHAGE, 
506 

Auto-transfusion, or actual transfusion of weak 

salt solution, necessary in some cases, 583 
Beef-tea, % pint, and morphine, gr. 1-8 hypo- 

dermically, after reaction is established, 

583 
Enema, of hot water, 1 pint, after cessation of 

bleeding, 583 
Ergot, as a cure and prophylactic, 507 
Ether, hypodermically, if symptoms of shock 

are manifested, followed by small doses of 

hot, strong brandy and water, and warm 

milk, 583 
Hirst's method of controlling, 582 
Suture, if due to laceration, 581 

PRIAPISM. 

Hops, 192 

PROLAPSUS ANI A3STD RECTI. 

Injection of cold or hot water, often relieves, 
350 

PROSTATITIS, 497 

Cold-water injections and perineal douches, 
352 

Local treatment to prostatic urethra, and use 
of cold steel sounds in chronic types, 497 

Perineal incision, to evacuate pus, if abscess 
forms, 497 

Rest in bed, regulation of bowels, leeches to 
perineum, medication to render urine al- 
kaline, and morphine hypodermically or 
in suppository, 497 

Soft catheter, allowed to remain in bladder, if 
retention of urine is persistent, 497 

PROSTATORRHCEA. 

Cantharides, 113 



PRURIGO. 



Cantharides, 113 



57 o 



PRURITUS, 

Alum solution as a wash in pruritus vulvae, 58 
Arsenic, quinine, bitter tonics, cod-liver oil. 
alkaline diuretics or mineral waters in de- 
bility, and avoidance of condiments if 
mouth of vagina or urethra is affected, 
575 

44 



Calomel and lard (1 drachm to the ounce), 
locally applied, 238 

Cocaine, relieves temporarily, 576 

Cold douche and injections highly recom- 
mended in pruritus ani and vulvas, 351 

Goulard's extract, dilute, useful in pruritus 
pudendi, 223 

Hydrocyanic acid, locally applied, prescription 
for, 195 

Prescription for lotions and ointments, 575 

Salicylic acid, prescription for, 295 

Silver nitrate (gr. 20 to the ounce), locally ap- 
plied, preceded by cocaine, if itching is 
intense ; a 4- to 6-grain solution may re- 
lieve itching of pruritus pudendi, ani, and 
vulvas, 247, 576 

Sodium bicarbonate or borax (1 drachm to the 
pint) as a wash, relieves temporarily, 575 

Teucrium scordium, highly recommended by 
Brinton, 576 

Tobacco, 327 

PSORIASIS. 

Anthrarobin, 66 

Aristol, 326 

Arsenic, 79 

Baths of sulphides, very useful, 314 

Chrysarobin, gr. 1-8 internally, or the ointment 
with benzoated lard (1 to 4 or 5) locally ap- 
plied, face excepted, 139 

Gallic acid ointment, 181 

Prescription for application, 139 

Resorcin, prescription for, 289 

Tar. locally applied, 285 

Thymol iodide, 326 

PTYALISM. 

Alum applied on swab, in mercurial ptyalism, 

58 
Belladonna, in idiopathic or mercurial types, 



PUERPERAL DISEASES, 576 

For treatment, see special titles. 

PUERPERAL FEVER, 576 

Antipyretics, best abstained from as long as 
possible, 578 

Bichlorate of mercury (1 to 2000), or creolin 
(2 per cent.) solutions, as antiseptic injec- 
tions, 576 

Boric acid, creolin (2 per cent.), or bichloride 
(1 to 8000) solutions as injections into blad- 
der, to prevent septic cystitis, 580 

Curette or placental forceps, to remove mem- 
branes if fever continues after antiseptic 
injections, 577 

Epsom salts, concentrated solution, 2 drachms 
every fifteen minutes, if peritonitis de- 
velops, 578 

Laparotomy, occasionally saves life, if septic 
peritonitis develops, 578 

Nutriment in large amounts and alcoholic 
stimulants, if symptoms of systemic inva- 
sion arise, 578 

Silver nitrate (gr. 40 to 60 to the ounce), locally 
applied to unhealthy ulcerated wounds ; 
zinc chloride solution may be necessary. 
579 

Veratrurn viride, 333 



690 



INDEX OF DISEASES AND REMEDIES. 



PURPURA HEMORRHAGICA. 

Turpentine, 328 

PYELITIS. 

Buchu, in chronic types, 100 

€antharides, 113 

Copaiba, 158 

Juniper, as a tonic in chronic types, 217 

Uva ursi, 330 

QUINSY. 

Aconite, in early stage, 47 
Salicylic acid, gr. 3 hourly, acts as a specific, 
especially if due to rheumatism, 295 

REMITTENT FEVER, 587 

Antipyrine, or cold pack, if fever is excessive, 
587 

Eupatorium, 178 

Monsel's salt, gallic or tannic acid internally, 
if intestinal haemorrhage occurs, 588 

Morphine, spirit of chloroform, or aconite, in 
sthenic cases, to control vomiting, 587 

Quinine, gr. 20 to 30, preceded by calomel, gr. 
3 to 4 ; if not retained, administer by rec- 
tum, or hypodermically, with divided doses 
of Seidlitz powder by mouth, 587 

Tonics, potassium salts, to regulate kidneys, 
and purgatives, if necessary, during con- 
valescence, 588 

Turpentine stupe, if belly is tender, 587 

RETINITIS, 588 

Atropine, dark glasses and later suitable lenses 
if due to eye-strain, 588 

RHEUMATISM, ACUTE 
ARTICULAR, 588 
Acetanilide, relieves pain and fever, 43, 590 
Acetate of potassium, 43 
Aconite, or veratrum viride, useful at onset of 

inflammation in sthenic cases, 588 
Alcohol, in depression, 589 
Ammonium bromide, 62 
Antipyrine, gr. 10 to 20, or antifebrin, gr. 4 to 

8, often very valuable, 590 
Benzoic acid, drachm 2 to 3, daily, said to be 

a specific, 89 
Bicarbonate or citrate of potassium, gr. 20 to 

30, in water, every five hours, in obstinate 

cases, 591 
Blisters over joints, useful after systemic dis- 
turbance is past, 592 
Camphor liniment, 108 
Capsicum plaster, 115 
Cimicifuga, shortens attack and relieves pain 

in some cases, 592 
Colchicum, prescription for, 591 
Cold pack, if fever threatens life, 592 
Fuller's lotion, applied on hot cloths to joints, 

589 
Ice-cold compress, may relieve inflamed joints, 

589 
Ichthyol ointment, valuable applied to joints, 

prescription for, 592 
Iodine, ointment or tincture, painted over 

parts, 592 
Lemon- or lime-juice, or citric acid, beneficial 

in nearly all cases, 592 



: Oil of gaultheria, useful as a substitute for 
salicylic acid, 590 

Phenacetine, alone or with salol, 591 

Potassium iodide, useful in subacute or obsti- 
nate types, prescription for, 591 

Potassium nitrate, 245 

Rhus toxicodendron, especially useful for 
night pains, 592 

Salicylic acid, gr. 20, thrice daily, if untoward 
symptoms arise must be stopped, 589 

Salol, useful as a substitute for salicylic acid, 
dangerous in large doses, 592 

Sodium bicarbonate (gr. 20 to the ounce), ap- 
plied on lint to inflamed joints, 589 

Splints for fixation of limbs, may relieve 
greatly, 589 

Sulphur, 317 

Veratrine ointment, useful locally applied to 
joints, 592 

RHEU.VIATISM, CHRONIC, 593 
Arsenic, useful in some cases, 79 
Baths of sulphides, often useful, 314 
Cimicifuga, sometimes relieves, 140 
Citrate of potassium or sodium, gr. 30 to 60, 

before retiring, 295 
Cod-liver oil, internally, in weakness or an- 
aemia, also useful rubbed into joints, 593 
Ichthyol, the best remedy for joints, 594 
Iodine, locally applied, 594 
Liniments, prescriptions for, 593 
Ointments, prescriptions for, 594 
Potassium iodide, colchicum, and sarsaparilla, 

usually indicated ; see prescription, 593 
Turkish or Russian baths, very valuable, 593 
Veratrine ointment, gives greatest relief in 
some cases, prescription for, 594 

RHEUMATISM, MUSCULAR. 

Burgundy pitch, a mild local remedy, 284 
Dover's powder, in conjunction with hot drinks 

and hot foot-bath, often cures, 262 
Mustard, as a counter-irritant, 243 
Veratrine ointment, locally applied, 331 

RHINITIS. 

Creolin (1 to 1000), as a nasal douche, 162 
Fluid cosmoline, in spray, 273 
Potassium permanganate, solution, in foetid 
rhinitis, 272 

RICKETS, 594 

Arsenite of copper, 595 

Cinchona, for child of one year or more, pre-* 
scription for, 594 

Cod-liver oil, prescription for, 595 

Cool sponging or rubbing with salt and whis- 
key (1 drachm to the pint), useful at night, 
596 

Iodide of iron, syrup of, if scrofulous tendency 
or anaemia exists, prescriptions for, 595 

Lime salts, phosphorus, zinc phosphate, and 
as bone tonics, 595 

Massage and passive movements, 596 

Mineral acids, physostigma and simple bitters, 
as digestive tonics, 595 

Nux vomica, rarely given because of bitter- 
ness, 595 

Phosphate of lime or sodium, gr. 1 to 2, in 
child's milk, 596 



INDEX OF DISEASES AND REMEDIES. 



691 



Phosphorus (gr. 1-100), in sugar-coated pill, 

595 
Quinine, cod-liver oil, nux vomica, and iron 

as general tonics, 595 
Sodium and lime salts, useful in nursing and 

pregnant women, 595 

RINGWORM. (See Tinea Circinata.) 
SATYRIASIS. 

Potassium bromide, one of the best remedies, 
95 

SCABIES. 

Sulphur, the best remedy, 317 

SCARLET FEVER, 596 

Aconite, harmful, 47 

Alcohol, indicated in collapse, 598 

Antipyrine or acetanilide.mayproduce collapse 

in large doses, 598 
Bromide of sodium with chloral, useful when 

convulsion ushers in attack, 598 
Carbolic acid (gtt. 2 to olive oil oz. 2), ben- 

zoated lard, vaseline, cosmoline, or almond 

oil, useful, locally applied, to allay itch- 
ing, 599 
Chloral, very useful, prescription for, 596 
Chlorate of potassium, locally applied, by spray 

or swab, in sore-throat, 598 
Cold sponging, useful ; pack must be employed 

if fever is excessive, 598 
Ice, applied externally and held in mouth, to 

prevent swelling of throat, 598 
Ice-bag or rubber head-coil to head, if very 

hot, 598 
Jalap, compound powder, with potassium bi- 

tartrate, or hot dry applications, to produce 

sweat, in nephritis, 599 
Juniper, in later stages, if there is renal atony, 

217 
Pilocarpine, best agent to produce sweating in 

nephritis ; contra-indicated if heart is 

weak, 599 
Potassium citrate and sweet spirit of nitre, 

prescription for, 597 
Quinine, unsuccessful in most cases, 598 
Salicylic acid, highly recommended, prescrip- 
tion for, 596 
Strychnine, iron, simple bitters, quinine, or 

Basham's mixture, in convalescence, 599 
Warm wet pack, useful to bring out rash, 599 
"Water, pure, as Vichy or Poland, in large 

amounts, 597 

SCIATICA, 599 

Acupuncture, recommended, 600 

Antifebrin and antipyrine, may prove useful, 

600 
Cod-liver oil, of service in obstinate cases, 600 
Chloroform, deeply injected over exit of nerve, 

a favorite remedy, 600 
Ether or rhigolene, sprayed on part, often effec- 
tive, 600 
Kataphoresis, may be tried, 600 
Liniments for rheumatism may be tried, 600 
Massage of nerve with glass rod, 600 
Morphine, injected over course of nerve, 600 j 
Nerve-stretching, necessary in some cases, 600 | 



Potassium bitartrate or citrate, gr. 40, thrice 
daily, in plenty of water, to regulate kid- 
neys, 600 

Potassium iodide, 200 

Remedies for rheumatism, often relieve, 600 

Salicylic acid, 295 

Sulphur, 311 

Wet cups, highly beneficial over course of 
nerve, 600 

SCLERITIS, 600 

Atropine, boric acid, and hot-water com- 
presses, to control pain in early stage, 600 

Eserine, with pilocarpine sweats or cautery in 
stubborn episcleritis without iritis, 600 

Yellow oxide ointment, associated with mas- 
sage, to subdue infiltration, 600 

SCLEROSIS. 

Antipyrine, 73 
Nitrate of silver, 246 

SCROFULOSIS, 601 

Arsenic or corrosive sublimate,useful if anoeroia 
is present, prescriptions for, 601 

Calcium chloride, 104 

Cod-liver oil, the best remedy, 601 

Diet and exercise, 601 

Europhen in scrofuloderm, 179 

Excision, or scraping gland, and packing with 
iodoform gauze, if other treatments fail,602 

Ichthyol ointment, useful, rubbed into persis- 
tent enlargements, prescription for, 602 

Iodine ointment and lard, equal parts, rubbed 
into glands, stopping at first sign of red- 
dening or fluctuation, 602 

Iron, syrup of the iodide, in anaemia, prescrip- 
tion for, 601 

Lactophosphates, or hypophosphates, with 
cod -liver oil, useful in young children, 601 

Phosphate of sodium or lime, if glands are 
breaking down, 601 

Sulphurate of calcium, if suppuration is active, 
601 

Thiol, recommended in scrofulous skin dis- 
eases, 325 

SCURVY, 602 

Arsenic and iron, of service in most cases, 566 
Citric acid, if lemon-juice is not obtainable, 

602 
Diet, 602 
Lemon- or lime-juice, particularly indicated, 

602 

SEA-SICKNESS. 

Bromides, the best prophylactics, 96 
Nitrite of amyl, 58 

SEAT-WORMS. (See Worms.) 



SHOCK, 602 

Alcohol, 50" 

Atropine, gr. 1-60 to 1-50, hypodermically, with 

hot applications, very useful in first or 

second stage, 603 
Digitalis, valuable as an adjuvant to atropine, 

604 



692 



INDEX OF DISEASES AND REMEDIES. 



SKIN DISEASES. 

Arsenic, in dry, scaly types, 78 

Cod-liver oil, in strumous types, 152 

Copper sulphate, gr. 1-10, thrice daily, if arsenic 
is not well borne, 160 

Corrosive sublimate, oz. %, and ammonium 
chloride, oz. 1, useful, added to bath in 
syphiloderm, 235 

Hydrocyanic acid, in itching types, prescrip- 
tion for, 195 

Ointment of yellow oxide and lard, in equal 
parts, a useful application, 240 

Petrolatum, as an emollient dressing, 273 

Tar and suet, equal parts, locally applied ex- 
cept on face, 285 

Unguentum hydrargyri ammoniati, 234 

Zinc oxide ointment, 265 

SMALLPOX, 604 

Aconite, with spirits of nitre and Mindererus, 

useful as a fever mixture, 604 
Antipyrine or acetanilide, to control headache 

and backache, 604 
Brandy and whiskey, if pulse fails, 604 
Bromides and chloral, in insomnia ; latter used 

carefully, 604 
Carbolic acid and sweet oil (1 to 100), as an 

ointment to check irritation, 605 
Chlorate of potassium with tincture of myrrh, 

as a mouth-wash, 605 
Flexible collodion, glycerite of starch or simple 

cerate, locally applied, to prevent itching, 

604 
Iron, tincture of the chloride, to give strength 

and act as a specific, 604 
Salicylic acid and vaseline, or cold cream (4 to 

100), best local application, 605 
Silver nitrate, locally applied, to prevent pit- 
ting, 604 

SOEDES. 

Glycerin and water, equal parts, useful as a 
mouth-wash, 186 

SOKES. 

Black wash, useful for syphilitic sores, 236 
Camphor, locally applied, as a stimulant in 

indolent sores, 108 
Charcoal, applied to old sores, as a deodorant 

and antiseptic, 119 
Cold cream, as an emollient dressing, 291 
Iodoform, gr. 20, with oil of eucalyptus, oz. %, 

or iodoform, oz. %, camphor, gr. 75, and 

essence .of roses, gtt. 2, as a dressing for 

syphilitic sores, 207 
Petrolatum, as an emollient dressing, 273 
Potassium permanganate (gr. 60 to the pint), 

as a wash, 272 
Quercus alba, powdered, as a poultice, to 

check discharge, 288 
Red or yellow oxide of mercury, with chalk. 

equal parts, a good dressing for syphilitic 

sores, 240 
Sulphuric acid, sometimes used as an eschar- 
otic in venereal sores, 318 
Zinc oxide ointment, 265 

SORE-THROAT. 

Aconite, in early stage, 47 
Alum (gr. 20 to the ounce), locally applied on 
swab, 57 



Belladonna of greatest service in some cases, 

87 
Capsicum, tincture of, and glycerin, equal 

parts, locally applied on a swab, 114 
Carbolic acid (1 to 100), in spray, in ulcerated 

types, 118 
Catechu, as a gargle or in troches, 125 
Copper sulphate (gr. 4 to the ounce), often of 

service in relaxed sore-throat, 160 
Hydrogen peroxide (2 per cent, strength), in 

spray, in foetid types, 267 
Kino, as a gargle, 218 
Myrrh, tincture of, diluted one-half, as a 

gargle, in ulcerated types, 244 
Quercus alba, useful as a gargle, 288 
Quinine (gr. 1 to 2 to the ounce), in spray, in 

foetid sore-throat. 143 
Rhus glabra, with glycerin and water, useful 

as a gargle, 291 

SPASMS. 

Belladonna, useful in urethral, anal, and 

vesical spasms, 86 
Cannabis indica, useful in vesical spasm, 111 
Conium, useful, if due to irritation of nerve- 
trunk, 157 
Ether, inhalation, relieves local spasms, 173 
Nitrite of amyl, of service to relax, 65 

SPERMATORRHOEA. (See Emissions.) 

SPRAINS. 

Arnica, 76 

Camphor liniment, 108 

Cold applications, useful in sprained ankle, 345 

Hot foot-bath, prolonged for hours, very use- 
ful in sprained ankle, 360 

Ichthyol ointment, well rubbed in, very use- 
ful, 198 

Lead- water and laudanum, 222 

Soap liniment, 284 

Soap plaster, used as a support to sprained 
joints, 306 

Turpentine liniment, 329 

STINGS AND BITES, 605 

Ammonia or alkaline liquids, locally applied 

to neutralize poison, 605 
Carbolic acid (1 to 50 or 100), sponged over part, 

useful in mosquito-bites. 605 
Corrosive sublimate, with flexible collodion 

(1 to 1000), painted over part ; salicylic 

acid a useful addition, 605 
Ligature, or cleansing of wound, at once, to 

prevent absorption in snake-bite, 605 
Potassium permanganate, applied and injected 

around snake-bite, followed by alcohol in 

full dose, 605 
Vinegar, dilute or pure, locally applied, often 

relieves insect-bites, 605 

STOMATITIS, 605 

Borax, as a mouth-wash, prescription for, 606 
Bromide of potassium or sodium, gr. 1 to 3, 
thrice daily, when nervous irritability is 
excessive, 606 
Carbolic acid, as a mouth- wash, 118 
Cocaine, locally applied, if spot is to be cauter- 
ized, 149 



INDEX OF DISEASES AND REMEDIES. 



693 



Nitrate of silver, stick touched to sore spots 
when they fail to yield to other treatment, 
606 

Nitric acid, gtt. 3 in water, taken through 
tube, 249 

Nitro-muriatic acid, indicated when hepatic 
torpor exists, 606 

Peroxide of hydrogen, 606 

Prescription for, 605 

Salicylic acid (1 to 250), as a mouth- wash, after 
blisters have broken, to allay pain, 295 

Salines or rhubarb, if constipation exists, 606 

Sozoiodol (5 per cent, solution), locally ap- 
plied, 309 

Sweet spirit of nitre, 10 drops, well diluted, to 
a one- or two-year-old child, and a warm 
foot-bath, before retiring, to produce rest, 
606 

Thymol, prescription for, 326 

Tonics and careful diet after the attack, 606 

STYES, 606 
Boric acid (saturated solution), collodion 
(ethereal solution), or red or yellow oxide 
of mercury salve (gr. 8 to the drachm), 
locally applied, to abort, 606 
Calcium sulphurate, if they tend to return, 607 
Hot compresses, to alleviate pain, 606 
Incision, as soon as pus forms, 606 
Tonics, if general health is poor, 606 

SUBINVOLUTION OF UTERUS. 

(See Involution, Anomalies of.) 

SUNBURN. 

Almonds, in emulsion, 54 

SUNSTROKE, 607 

Antipyretics, almost useless, 608 

Hot baths (105° to 110° F.), or hot bottles or 

bricks, in heat exhaustion, 608 
Ice application to chest, back, and abdomen, 

as quickly as possible, in thermic fever, 

607 
Salicylic acid, quinine, and similar drugs 

contra-indicated, 608 
Tonics, during convalescence in heat exhaus- 
tion, 608 
Venesection, best treatment, if meningitis 

threatens, after thermic fever, 608 
Veratrum viride may be used if meningitis 

threatens, 608 

SYNCOPE. 

Ammonia, if due to shock or indigestion, 60 

SYNOVITIS. 
Carbolic acid (2 per cent, strength), as an in- 
jection in chronic types, 118 
Counter-irritation, 355 

SYPHILIS, 608 

Bismuth and calomel, as a dusting-powder, or 
bichloride solution (1 to 2000), locally ap- 
plied to mucous patches about genitalia, 
611 

Calomel, gr. %, every two hours, for cephal- 
algia, 611 

Cod-liver oil, useful in advanced cases, 613 

Expectant plan of treatment, 609 



Iodides, followed if necessary by mercury, 
recommended by some, 610 

Iodoform, gr. 1 to 5, internally in tertian- 
stage, and the ointment applied to ulcers, 
very useful, 207, 613 

Mercury, at beginning of secondary stage, fol- 
lowed later by the iodides, the most com- 
monly accepted treatment, 610 

Mercury by fumigation, general and local, 232 

Mercury, with chalk, chiefly employed in in- 
fantile syphilis, 238 

Mixed treatment, 611 

Ointments and washes of mercury, and hot 
applications to combat surface eruptions, 
611 

Prescription for blue mass and iron, 612 

Prescription for potassium iodide and mer- 
cury, to be used after first eighteen months, 
611 

Pressure bandage and mercurial inunctions 
for periostitis, 611 

Russian baths highly recommended, 362 

Sarsaparilla, a useful adjunct to potassium 
iodide, 301 

Shampooing and local application of croton 
oil or cantharides, as a lotion, to combat 
alopecia, 611 

Silver nitrate, copper sulphate, chromic acid 
solution (20 per cent.), or acid nitrate of 
mercury,locally applied to mucous patches 
in mouth, 611 

Stillingia, used as an aid to other drugs, 311 

Thiol, in syphilides, 325 

Tonic and general treatment, 613 

Vapor baths, hypodermic injections, or inunc- 
tions, useful modes of applying mercury, 
if it cannot be taken by mouth, 612 

SYSTEMIC STRAIN. 

Quinine, gr. 2 to 4, useful to prevent exhaus- 
tion following physical and mental strain, 
143 

Opium, useful in prolonged physical strain, 
262 

TABES DORSALIS. (See Locomotor 

Ataxia.) 
Chloralamide, 130 

TAPE-WORM. (See Worms.) 

TEETHING. 

Bromide of potassium, to prevent convulsions, 
96 

TETANUS. (See Poisoning from 
Strychnine.) 

Amyl nitrite, to relieve and prevent, 65 
Chloral and bromide of potassium, by mouth 

or rectum, 128 
Fowler's solution said to be almost specific in 

some cases, 613 
Physostigma, of moderate value, 286 

TINEA CAPITIS. 
Lime-water, locally applied, 106 

TINEA CIRCINATA. 

Borax, strong solution, locally applied, 92 



691 



INDEX OF DISEASES AND REMEDIES. 



Iodine, applied with camel's-hair brush , 204 
Turpentine, useful, applied with a brush, 329 

TINEA TARSI. 

Copper, crystal, or weak solution, applied to 
diseased eyelid, 160 

TINEA TONSURANS. 
Borax, strong solution, locally applied, 92 
Iodine, applied with camel's-hair brush, 204 
Oil of cajuput, applied pure, 103 

TOE-NAIL, INGROWING. 

Absorbent cotton, soaked in strong alum solu- 
tion, and inserted under nail, 58 

Liquor potassse, to soften nail prior to packing 
with cotton or partial evulsion, 226 

TONSILLITIS. 

Alum stick, deeply applied, 58 

Glycerin and tincture of capsicum, equal 
parts, applied by swab, 186 

Hydrogen peroxide (2 per cent, strength), in 
spray, in ulcerative types, 267 

Iron, tincture of the chloride, locally applied, 
212 

Monsel's solution, pure, applied with camel's- 
hair brush, 214 

TOOTHACHE. 

Creasote, applied on cotton, often relieves, 161 
Oil of cloves, inserted into cavity on cotton, 

148 
Oil of peppermint, applied on cotton, 270 

TORPOR. 

Ammonium chloride, in hepatic torpor, 63 
Euonymus, in mild hepatic torpor, 178 
Lactophosphates and hypophosphites, useful 

in hepatic torpor, 104 
Nitro-hydrochloric acid, in torpor of liver, 257 
Oxygen water, after meals, useful in systemic 

torpor, 266 
Potassium acetate, exceedingly useful in he- 
patic torpor, 43 
Russian and Turkish baths, useful in torpidity 

of skin and kidneys, 363 
Taraxacum, in hepatic torpor, 322 

TORTICOLLIS. 

Belladonna, injected into muscle, 86 
Gelsemium, 183 

TUBERCULOSIS, 614 

Acetanilide, generally acts unfavorably, 42 
Almonds, essential oil of, recommended in 

cough, 54 
Alum (gr. 10 to 20 to the ounce), or sulphuric 

acid (1 drachm to the pint), useful sponged 

over body in night-sweats, 619 
Antipyrine, harmful, 72 
Arsenic, in phthisical tendencies, 78 
Atropine, gr. 1-60 to 1-50, hypodermically, in 

excessive night-sweats, 619 
Blister, small, useful over new pleuritic spots, 

618 
Camphoric acid, gr. 20 to 30, invaluable, 619 
Cannabis indica, 110 
Carbolic acid (gtt. 5 to 15 to the ounce), in 

spray, 117 



Chloroform, spirit of, used by inhaler, often 
relieves cough, 618 

Climatic treatment, 615 

Codeine, recommended in excessive cough, 
142 

Cod-liver oil, rules for its use, 617 

Creasote, internally, in spray, or by inhaler, 
often relieves cough and discomfort ; con- 
tra-indicated if fever and haemoptysis are 
present ; prescription for, 617 

Glycerin and water, equal parts, with lemon- 
juice, useful as a mouth-wash, 186 

Hydrogen peroxide (2 per cent, strength), in 
fine spray in laryngeal phthisis, 267 

Inhalations of steam from corrosive sublimate 
solution (1 to 10,000), stopping at first sign 
of mercurial effects, in laryngeal phthisis ; 
precede inhalation with cocaine spray (4 
per cent, solution), 618 

Iodine, useful, painted over new pleuritic 
spots, also useful in chronic cases as an 
inhalation, 204, 618 

Iodoform with small amount of powdered talc 
and a little morphine, useful when puffed 
into the larynx in laryngeal tuberculosis, 
619 

Lactic acid applications (10 to 60 per cent, 
solution), in laryngeal tuberculosis, using 
cocaine spray first to relieve pain, 618 

Lactophosphates and hypophosphites, useful 
in some cases, 104 

Morphine and wild cherry bark, in cough, 
prescription for, 618 

Opium, may be given in last stage, to relieve 
pain and discomfort, 262 

Oxygen, inhalations in dyspnoea, 267 

Pilocarpine, gr. 1-20, one to two hours before 
sweat, sometimes arrests ; if it or atropine 
fails alone, give them together, 619 

Potassium cyanide, in excessive cough, pre- 
scription for, 164 

Silver nitrate (gr. % to 2 to the ounce), in 
spray, may be tried in laryngeal types, 247 

Strychnine, in dyspnoea, 256 

Sulphuric acid, internally, may relieve night- 
sweats, 619 

TYPHOID FEVER, 619. (See Fever.) 

Acetanilide, generally acts unfavorably, 42 

Alcohol, useful throughout course of disease, 
621 

Asafoetida, by rectal injections, in tympanites, 
81 

Brand's method of cold bathing, 623 

Calomel, gr. %, every fifteen minutes, till gr. 1 
is taken, followed by magnesium sulphate, 
% ounce, if constipation lasts two days, 
622 

Cold, 353, 623 

Enemas, to be tried first, if constipation lasts 
over two days, 622 

Glycerin and water, equal parts, with a little 
lemon-juice, as a mouth- wash, if sordes 
are present, 622 

Hydrochloric acid, dilute, gtt. 5, every few 
hours, or, if bowels are inactive, nitro- 
hydrochloric acid, gtt. 3, 622 

Lime-water added to milk, if vomiting threat- 
ens, 622 



INDEX OF DISEASES AND REMEDIES, 



695 



Liquorice powder, drachm 1, if constipation 
lasts over two days, 622 

Morphine in large dose, if perforation occurs, j 
623 

Phosphorus if nervous system is affected, 278 

Prescription for diarrhoea, 622 

Quinine inferior to new antipyretics, 143 

Rest and diet, 621 

Silver nitrate, gr. % to %, highly recom- 
mended, 247 

Turpentine, in the form of stupes, enemata, or 
by mouth, in tympanites, also useful in 
later stage, to relieve diarrhoea, heal ulcers, 
and prevent relapse, 622 
For remedies for complications — intestinal ] 

haemorrhage, pneumonia and pleurisy — see I 

their titles. 

ULCERS. 

Alcohol, a useful local application, 50 

Aristol, 326 

Benzoate of hismuth, as a dressing for indolent 
or sloughing ulcers, 88 

Burnt alum, as a dressing for old ulcers, 58 

Caustic potash, as an escharotic for exuberant 
ulcers, 125 

Chimaphila, said to he of service in strumous 
ulcers, 126 

Copper, in solid or powder form, locally ap- 
plied to indolent ulcers, 160 

Creolin, solution (1 to 100), as a douche for 
nasal ulcers, 162 

Europhen, in ■ 10 per cent, ointment, in leg 
ulcers, 179 

Gallic acid ointment, in actively discharging 
ulcers, 181 

Hamamelis, locally applied on a cloth, relieves 
leg ulcers, 189 

Hydrogen peroxide, a useful application, 267 

Lime, as an escharotic in old ulcers, 106 

Nitric acid, as a caustic for phagedsenic ulcers, 
or a solution (gtt. 5 to 30 to the ounce), 
locally applied to indolent types, 248 

Ointment of lead carbonate, as a dressing, 222 

Potassium permanganate (gr. 60 to the pint), 
as an antiseptic wash, 272 

Precipitated carbonate of calcium, as a dry 
dressing, 104 

Silver nitrate, in hard pills for intestinal ulcers 
and by injections for rectal and cseeal 
ulcers, 246 

Sulphuric acid, sometimes used as an eschar- 
otic in slow ulcers, 318 

UREMIA. 
Elaterium, thought to aid elimination of poi- 
son by the bowel, 168 
Pilocarpine, the most efficient remedy, 282 

URIC ACID DIATHESIS. 

Acetate of potassium, 44 

Lime-water, 106 

Piperazine in the dose of 15 grains a day in 

1 pint of water, 283 
Prescription for prevention of formation of 

calculi, 93 

URTICARIA. 

Ichthyol ointment, highly recommended, 196 



UVULA, RELAXED. 

Capsicum, tincture of, and glycerin, equal 
parts, as a gargle, 115 # 

Kino, as a gargle, 218 

VARICOCELE. 

Cold water, applied by bidet, highly recom- 
mended, 349 

VARICOSE VEINS. 

Barium chloride, internally and locally ap- 
plied , said to be of value, 83 

Hamamelis, useful internally or injected into 
part, 189 

VITREOUS DISEASES, 624 

Antisyphilitic treatment, if due to syphilis, 624 

Galvanism, 624 

Leeches, in early stage if due to inflammation, 

624 
Pilocarpine, hypodermically, 624 

VOMITING, 624. 

Bismuth and aconite may be of service, pre- 
scription for, 626 

Bromide of sodium or potassium with lauda- 
num, as a rectal injection in obstinate 
cases, prescription for, 97, 695 

Calomel, 238 

Carbolic acid with bismuth, useful in acidity 
and fermentation, prescription for, 626 

Chloroform, gtt. 1 to 2, in water, 626 

Cloves, oil of, sometimes controls, 148 

Cocaine or aconite, if due to hyper-excitability 
of stomach, 625 

Enemas, partially digested, if vomiting is in- 
coercible, 627 

Fowler's solution, gtt. % to 1. every two hours, 
useful in nausea following debauch, also 
in other cases, instead of ipecac or nux 
vomica, 626 

Hydrochloric acid, gtt. 5 to 15, in water, every 
two hours, in alcoholic nausea, 627 

Hydrocyanic acid, dilute, gtt. 2 to 6, in water, 
195, 626 

Ice-bag, to nape of neck, lumbar region, or 
epigastrium, 627 

Ipecac, in small doses, if due to gastric depres- 
sion, 626 

Lime-water, added to milk, may relieve nau- 
sea, 627 

Mustard plaster over stomach, useful in all 
cases, 627 

Nux vomica, if due to gastric depression, pre- 
scription for, 626 

Oxygen water, of great service, 266 

Peptonized milk, best food, 627 

Podophyllin, useful in gastric depression and 
hepatic torpor, 285 

Seidlitz powder, often settles stomach, if due to 
constipation, 303 

VOMITING OF PREGNANCY. 

Aconite, as a nervous sedative, 47 

Arsenic, may be tried, 79 

Bromide of potassium, as an effervescing 
draught, or with opium by enema, pre- 
scriptions for, 97 



696 



INDEX OF DISEASES AND REMEDIES. 



Cerium oxalate, gr. 2 to 5 in pill, every four or 

five hours, 126 
Cocaine, useful to decrease irritability, 150 
•iodine, tincture of, largely used of late with 

good results, 206 
Ipecac wine, gtt. 1, or powder, gr. 2, useful in 

some cases, 209 
Menthol, very useful, 271 

WARTS. 

Acetic and salicylic acids combined, 44 
Chromic acid (gr. 100 to the ounce), locally ap- 
plied, to remove, 139 
Fowler's solution, locally applied, 79 
Glacial acetic acid, useful to remove, 44 
Nitric acid, as a caustic, 249 

WHITE SWELLING. 

Iodine. 204 

WHOOPING-COUGH, 627 

Aconite or veratrum viride, if vascular en- 
gorgement is excessive, 627 

Amber, oil of, 58 

Amyl nitrite, when paroxysms interfere with 
respiration, 628 

Antipyrine, gr. % to 3, every five hours, prob- 
ably tbe best remedy, 627 

Belladonna, tincture of, gtt. %, thrice daily, to 
child of one or two years, 627 

Benzine, 628 

Cannabis indica, sometimes of service, 111 

Carburetted hydrogen, 627 

Chloral, 129 

Chloride of gold and sodium has been recom- 
mended, 187 

Chloroform, a few whiffs if paroxysms inter- 
fere with respiration, 628 

Gelsemium. 183 

Hyoscyamus, probably better than belladonna, 
196 

Milk, in small amounts, may overcome vomit- 
ing following paroxysms, 628 

Monobromated camphor, 109 

Prescription for, 266 

Quinine (gr. 1 to the ounce), in spray useful, 
also of service in exposed children as a 
prophylactic, 143 

Resorcin, gtt. 10 of a 2 per cent, solution in- 
ternally, or, better, in spray, 289 



Silver nitrate (gr. % to 1 to the ounce), in spray, 
used when stomach is empty, 247 

"WORMS, 628 

Aspidium, very efficient against tape-worm, 
prescription for, 82, 629 

Azedarach, a useful remedy against round- 
worms, 82 

Brayera, as an infusion, or fluid extract, 
against round-worms, 629 

Calomel, should follow or precede all drugs 
used for tape-worm, 629 

Castor oil, or a saline purgative, should follow 
remedies for round- worms, 629 

Chenopodium, oil of, gtt. 5 to 20, on sugar, to 
remove round-worms, 629 

Chloroform, should not be used against tape- 
worm, 138 

Kamala, drachms 1 to 2, in syrup, against tape- 
worm, 218 

Koosin, gr. 40 to adult, against round- worms, 
contra-indicated in pregnant women, 629 

Pelletierine, gr. 1 to 2, in capsule, best remedy 
against tape-worm, 629 

Pepo, oz. 2, in confection, against tape- worm, 
629 

Quassia injections, preceded by soap and water, 
most useful remedy against seat-worms, 
288 

Rue, should not be used against round- worms, 
292 

Rules for diet, preceding teeniacides, 628 

Salicylic acid, gr. 8, hourly till gr. 40 are taken, 
against round-worms, or as an injection 
against seat-worms, prescription for, 295 

Santonin, gr. % to %, in troches, for child, 
against round-worms, 629 

Spigelia, alone, or better, with senna, to re- 
move round- worms, 628 

Turpentine and castor oil, equal parts, efficient 
but somewhat dangerous, against tape- 
worm, 329 

WOUNDS. 

Collodion, as an air-tight dressing for small 

wounds, 155 
Potassium permanganate (gr. 20 to 60 to the 

pint), as an antiseptic wash, 272 
Sozoiodol, as an antiseptic and disinfectant in 

diseased Avounds, 309 



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tiRTlQURL HlGDH&flL DkJTIODAHY 



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Its scope is one which will at once satisfy the 
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nitions of words should form the prime feature of 
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different meanings of terms in use in medicine 
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HARTSHORNE, HENRY, A. M. 9 31. D., LL. L>., 

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A Conspectus of the Medical Sciences ; Containing Handbooks on Anatomy. 
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LUDLOW, J.L.,3I.L>., 

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A Manual of Examinations upon Anatomy, Physiology, Surgery, Practice of 
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HOBLYlSr, RLCHAKn P., M. JD. 

A Dictionary of the Terms Used in Medicine and the Collateral 
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Lea Brothers & Co.'s Publications — Anatomy, Dictionary, 5 
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books. The work is published with black and 
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Gray's Anatomy is the most magnificent work 
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As the book now goes to the purchaser he is re- 



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A work which for more than twenty years has 
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deed difficult to name a feature wherein the pres- j Gray's standard Anatomy has been and will be 
ent American edition of Gray could be mended j for years the text-book for students. The book 



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the royal work is destined for many years to come j stood. — Medical Press of Western New York, Jan. 
)ld f 



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DTJNGLISOIT, BOBLEY, M.Z>., 

Late Professor of Institutes of Medicine in the Jefferson Medical College of Philadelphia. 

MEDICAL LEXICON ; A Dictionary of Medical Science : Containing 

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It has the rare merit that it certainly has no rival in the English language for accuracy 

and extent of references. — London Medical Gazette. 



Lea Brothers & Co.'s Publications — Anatomy. 



ALLEN, HARRISON, M. L>., 

Professor of Physiology in the University of Pennsylvania. 

A System of Human Anatomy, Including Its Medical and Surgical 
Relations. For the use of Practitioners and Students of Medicine. With an Intro- 
ductory Section on Histology. By E. O. Shakespeare, M. D., Ophthalmologist to 
the Philadelphia Hospital. Comprising 813 double-columned quarto pages, with 380 
illustrations on 109 full page lithographic plates, many of which are in colors, and 241 
engravings in the text. In six Sections, each in a portfolio. Price per Section, $3.50 ; 
also bound in one volume, cloth, $23.00 ; very handsome half Russia, raised bands and 
open back, $25.00. For sale by subscription only. Apply to the Publishers. 



It is to be considered a study of applied anatomy 
in its widest sense — a systematic presentation of 
such anatomical facts as can be applied to the 
practice of medicine as well as of surgery. Our 
author is concise, accurate and practical in his 
statements, and succeeds admirably in infusing 
an interest into the study of what is generally con- 
sidered a dry subject. The department of Histol- 
ogy is treated in a masterly manner, and the 
ground is travelled over by one thoroughly famil- 
iar with it. The illustrations are made with great 



care, and are simply superb. There is as much 
of practical application of anatomical points to 
the every-day wants of the medical clinician as 
to those of the operating surgeon. In fact, few 
general practitioners will read the work without a 
feeling of surprised gratification that so many 
points, concerning which they may never have 
thought before are so well presented for their con- 
sideration. It is a work which is destined to be 
the best of its kind in any language. — Medical 
Record, Nov. 25, 1882. 



CLARKE 9 W. B., F.R.C.S. & LOCKWOOD,C. B., F.R.C.S. 

Demonstrators of Anatomy at St. Bartholomew's Hospital Medical School, London. 
The Dissector's Manual. In one pocket-size 12mo. volume of 396 pages, with 
49 illustrations. Limp cloth, red edges, $1.50. See Students' Series of Manuals, page 30. 



Messrs.Clarke and Lockwood have written a book 
that can hardly be rivalled as a practical aid to the 
dissector. Their purpose, which is "how to de- 
scribe the best way to display the anatomical 
structure," has been fully attained. They excel in 
a lucidity of demonstration and graphic terseness 
of expression, which only a long training and 



intimate association with students could have 

fiven. With such a guide as this, accompanied 
y so attractive a commentary as Treves' Surgical 
Applied Anatomy (same series), no student could 
fail to be deeply and absorbingly interested in the 
study of anatomy. — New Orleans Medical and Sur- 
gical Journal, April, 1884. 



HIRST, BARTON C, M.I)., & FIERSOL, GEO. A., M.J). 

Professor of Obstetrics in the University Professor of Anatomy and Embryology in 

of Pennsylvania. the University of Pennsylvania. 

Human Monstrosities. Magnificent folio, containing about 150 pages of text, 
illustrated with engravings, and 39 full- page, photographic plates from nature. In four 
parts, price, each, $5. Parts I. and II. just ready. Part III. shortly. Limited edition, for 
sale by subscription only. Address the Publishers. 



This, the second part of what bids fair to be the 
best teratological treatise extant, is fully up to the 
previous volume in point of excellence. The 

Slates are superbly executed and the illustrations 
ave been made with the specimens in the most 
advantageous positions for purposes of study. — 
The Journal of the American Medical Association, 
March 5, 1892. 

We have already referred at length to the salient 



points of this beautiful work, the second volume 
of which, containing the description of monstrosi- 
ties, is even more attractive than the first. There 
are more plates and less space devoted to the 
text We can only repeat that the work is one 
which reflects great credit upon American ob- 
stetric literature, and deserves a place in the 
library of every specialist and student of anatomy. 
—Medical Record, May 21, 1892. 



TREVES, FREDERICK, F. R. C. S., 

Senior Demonstrator of Anatomy and Assistant Surgeon at the London Hospital. 
Surgical Applied Anatomy. In one pocket-size 12mo. volume of 540 pages, 
with 61 illustrations. Limp cloth, red edges, $2.00. See Students' Series of Manuals, p. 30. 

BELLAMY, EDWARD, F. R. C. S., 

Senior Assistant-Surgeon to the Charing- Cross Hospital, London. 

The Student's Guide to Surgical Anatomy : Being a Description of the 
most Important Surgical Eegions of the Human Body, and intended as an Introduction to 
Operative Surgery. In one 12mo. volume of 300 pages, with 50 illustrations. Cloth, $2.25. 

WILSON, ERASMUS, F. R. S. 

A System of Human Anatomy, General and Special. Edited by W. H. 
Gobrecht, M. D., Professor of General and Surgical Anatomy in the Medical College of 
Ohio. In one large and handsome octavo volume of 616 pages, with 397 illustrations. 
Cloth, $4.00; leather, $5.00. - 

CLELAND, JOHN, M. D., F. R. S., 

Professor of Anatomy and Physiology in Queen's College, Oalway. 

A Directory for the Dissection of the Human Body. 
volume of 178 pages. Cloth, $1.25. 



In one 12mo. 



HARTSHORNE'S HANDBOOK OF ANATOMY 
AND PHYSIOLOGY. Second edition, revised. 
In one royal 12mo. volume of 310 pages, with 220 
woodcuts. Cloth, $1.75. 



HORNER'S SPECIAL ANATOMY AND HISTOL- 
OGY. Eighth edition, extensively revised and 
modified. In two octavo volumes of 1007 r a ge»» 
with 320 woodcuts. Cloth, $6.00. 



Lea Brothers & Co.'s Publications — Phys., Physiol., Anat., Chem. 7 



DRAPER, JOJBEW C, M. D., LL. D., 

Professor of Chemistry in the University of the City of New York. 
Medical Physics. A Text-book for Students and Practitioners of Medicine. In 
one octavo volume of 734 pages, with 376 woodcuts, mostly original. Cloth, $4. 

No man in America was better fitted than Dr. 



While all enlightened physicians will agree that 
a knowledge of physics is desirable for the medi- 
cal student, only those actually engaged in the 
teaching of the primary subjects can be fully 
aware of the difficulties encountered by students 
who attempt the study of these subjects without 
a knowledge of either physics or chemistry. 
These are especially felt by the teacher of physi- 
ology. 

It is, however, impossible for him to impart a 
knowledge of the main facts of his subject and 
establish them by reasons and experimental dem- 
onstration, and at the same time undertake to 
teach ab initio the principles of chemistry or phys- 
ics. Hence the desirability, we may say the 
necessity, for some such work as the present one. 



Draper for the task he undertook, and he has pro- 
vided the student and practitioner of medicine 
with a volume at once readable and thorough. 
Even to the student who hae some knowledge of 
physics this book is useful, as it shows him its 
applications to the profession that he has chosen. 
Dr. Draper, as an old teacher, knew well the diffi- 
culties to be encountered in bringing his subject 
within the grasp of the average student, and that 
he has succeeded so well proves once more that 
the man to write for and examine students is the 
one who has taught and is teaching them. The 
book is well printed and fully illustrated, and in 
every way deserves grateful recognition. — The, 
Montreal Medical Journal, July, 1890. 



POWER, JBOENRY, M. B., F. R. C. S., 

Examiner in Physiology, Royal College of Surgeons of England. 
Human Physiology. Second edition. In one handsome pocket-size 12mo. vol- 
ume of 509 pp., with 68 illustrations. Cloth, $1.50. See Students' Series of Manuals, p. 30. 

ROBERTSON, J. McGREGOR, M. A., M. B., 

Muirhead Demonstrator of Physiology, University of Glasgow. 
Physiological Physics. In one 12mo. volume of 537 pages, with 219 illustra- 
tions. Limp cloth, $2.00. See Students' Series of Manuals, page 30. 

The title of this work sufficiently explains the ments. It will be found of great value to the 
nature of its contents. It is designed as a man- practitioner. It is a carefully prepared book of 
ual for the student of medicine, an auxiliary to reference, concise and accurate, and as such we 
his text-book in physiology, and it would be particu- heartily recommend it. — Journal of the American 
larly useful as a guide to his laboratory experi- Medical Association, Dec. 6, 1884. 



I) ALTON, JOHN C, M. B., 

Professor Emeritus of Physiology in the College of Physicians and Surgeons, New York. 

Doctrines of the Circulation of the Blood. A History of Physiological 
Opinion and Discovery in regard to the Circulation of the Blood. In one handsome 
12mo. volume of 293 pages. Cloth, $2. 



Dr. Dalton's work is the fruit of the deep research 
of a cultured mind, and to the busy practitioner it 
cannot fail to be a source of instruction. It will 
inspire him with a feeling of gratitude and admir- 
ation for those plodding workers of olden times, 
who laid the foundation of the magnificent temple 
of medical science as it now stands. — New Orleans 
Medical and Surgical Journal, Aug. 1885. 

In the progress of physiological study no fact 
was of greater moment, none more completely 



revolutionized the theories of teachers, than the 
discovery of the circulation of the blood. This 
explains the extraordinary interest it has to all 
medical historians. The volume before us is one 
of three or four which have been written within a 
few years by American physicians. It is in several 
respects the most complete. The volume, though 
small in size, is one of the most creditable con- 
tributions from an American pen to medical history 
that has appeared. — Med. & Surg. Rep., Dec. 6, 1884. 



BELL, F. JEFFREY, M. A., 

Professor of Comparative Anatomy at King's Colleae, London. 

Comparative Anatomy and Physiology. In one 12mo. volume of 561 pages, 

with 229 illustrations. Limp cloth, $2.00. See Students' Series of Manuals, page 30. 

The manual is preeminently a student's book — I it the best work in existence in the English 
clear and simple in language and arrangement. I language to place in the hands of the medical 
It is well and abundantly illustrated, and is read- student. — Bristol Medico- Chirurgical Journal, Mar. 
able and interesting. On the whole we consider | 1886. 



ELLIS, GEORGE VOTER, 

Emeritus Professor of Anatomy in University College, London. 

Demonstrations of Anatomy. Being a Guide to the Knowledge of the 
Human Body by Dissection. From the eighth and revised London edition. In one very 
handsome octavo volume of 716 pages, with 249 illustrations. Cloth, $4.25 ; leather, $5.25. 



ROBERTS, JOHN B., A. M., M. !>., 

Lecturer in Anatomy in the University of Pennsylvania. 
The Compend of Anatomy. For use in the dissecting-room and in preparing 
for examinations. In one 16mo. volume of 196 pages. Limp cloth, 75 cents. 

Wohler's Outlines of Organic Chemistry. Edited by Fittig. Translated 
by Ira Remsen, M. L\, Ph. D. In one 12mo. volume of 550 pages. Cloth, $3. 



LEHMANN'S MANUAL OF CHEMICAL PHYS- 
IOLOGY. In one octavo volume of 327 pages, 
with 41 illustrations. Cloth, $2.25. 

CARPENTER'S HUMAN PHYSIOLOGY. Edited 
by Henet Poweb. In one octavo volume. 



CARPENTER'S PRIZE ESSAY ON THE USE AND 
Abuse of Alcoholic Liquors in Health and Dis^ 
ease. With explanations of scientific words. Small 
12mo. 178 pages. Cloth, 60 cents. 



8 Lea Brothers & Co.'s Publications — Physiology, Chemistry. 



CHAPMAN, HENRY C, M. !>., 

Professor of Institutes of Medicine and Medical Juris, in the Jefferson Med. Coll. of Philadelphia, 

A Treatise on Human Physiology. In one handsome octavo volume of 
925 pages, with 605 fine engravings. Cloth, $5.50 ; leather, $6.50. 

It represents very fully the existing state of 
physiology. The present work has a special value 
to the student and practitioner as devoted more 
to the practical application of well-known truths 



which the advance of science has given to the 
profession in this department, which may be con- 
sidered the foundation of rational medicine. — Buf- 
falo Medical and Surgical Journal, Dec. 1887. 

Matters which have a practical bearing on the 
practice of medicine are lucidly expressed; tech- 
nical matters are given in minute detail; elabo- 
rate directions are stated for the guidance of stu- 
dents in the laboratory. In every respect the 
work fulfils its promise, whether as a complete 
treatise for the student or for the physician ; for 
the former it is so complete that he need look no 



farther, and the latter will find entertainment and 
instruction in an admirable book of reference. — 
North Carolina Medical Journal, Nov. 1887. 

The work certainly commends itself to both 
student and practitioner. What is most demanded 
by the progressive physician of to-day is an adap- 
tation of physiology to practical therapeutics, and 
this work is a decided improvement in this respect 
over other works in the market. It will certainly 
take place among the most valuable text-books. — 
Medical Age, Nov. 25, 1887. 

It is the production of an author delighted with 
his work, and able to inspire students with an en- 
thusiasm akin to his own. — American Practitioner 
and News, Nov. 12, 1887. 



WALTON, JOHN C, M. !>., 

Professor of Physiology in the College of Physicians and Surgeons, New York, etc. 

A Treatise on Human Physiology. Designed for the use of Students and 
Practitioners of Medicine. Seventh edition, thoroughly revised and rewritten. In one 
very handsome octavo volume of 722 pages, with 252 beautiful engravings on wood. Cloth,. 
$5.00; leather, $6.00. 

have never been in any doubt as to its sterling 
worth.— N. Y. Medical Journal, Oct. 1882. 

Professor Dalton's well-known and deservedly- 
appreciated work has long passed the stage at 
which it could be reviewed in the ordinary sense. 
The work is eminently one for the medical prac- 
titioner, since it treats most fully of those branches 
of physiology which have a direct bearing on the 
diagnosis and treatment of disease. The work is 
one which we can highly recommend to all our 
readers. — Dublin Journal of Medical Science, Feb.'83. 



From the first appearance of the book it has 
been a favorite, owing as well to the author's 
renown as an oral teacher as to the charm of 
simplicity with which, as a writer, he always 
succeeds in investing even intricate subjects. 
It must be gratifying to him to observe the fre- 
quency with which his work, written for students 
and practitioners, is quoted by other writers on 
physiology. This fact attests its value, and, in 
great measure, its originality. It now needs no 
such seal of approbation, however, for the thou- 
sands who have studied it in its various editions 



EOSTER, MICHAEL, M. !>., E. R. S., 

Prelector in Physiology and Fellow of Trinity College, Cambridge, England. 
Text-Book of Physiology. New (fourth) and enlarged American from the 
fifth and revised English edition, with notes and additions. In one handsome octavo vol- 
ume of 1072 pages, with 282 illustrations. Cloth, $4.50; leather, $5.50. 

the author largely adopted in a modified form in 



The appearance of another edition of Foster's 
Physiology again reminds us of the continued 
popularity of this most excellent work. There 
can be no doubt that this text-book not only con- 
tinues to lead all others in the English language, 
but that this last edition is superior to its prede- 
cessors. It is evident that the author has devoted 
a considerable amount of time and labor to its 
preparation, nearly every page bearing evidences 
of careful revision. Although the work of the 
American editor in former editions has been by 



this revision, much was still left to be done by the 
editor to render the work fully adapted to the wants 
of our American students, so that the American 
edition will undoubtedly continue to supply the 
market on this side of the Atlantic. The "work 
has been published in the characteristic creditable 
style of the Lea's, and owing to its enormous sale* 
is offered at an extremely low price.— The Medical 
and Surgical Reporter, Jan. 9, 1692. 



SIMON, W., Eh. JD., M. JD., 

Professor of Chemistry and Toxicology in the College of Physicians and Surgeons, Baltimore, and 
Professor of Chemistry in the Maryland College of Pharmacy. 

Manual of Chemistry. A Guide to Lectures and Laboratory work for Beginners 
in Chemistry. A Text-book, specially adapted for Students of Pharmacy and Medicine. 
New (third) edition. In one 8vo. volume of 477 pages, with 44 woodcuts and 7 colored 
plates illustrating 56 of the most important chemical tests. Cloth, $3.25. 



Among the many works on chemistry offered 
for the use of the medical student, there is prob- 
ably none that outrivals Dr. Simon's work in prac- 
tical arrangement and thoroughness. A special 
feature of the book, and one that deserves the 

§reatest praise, is the presence therein of the 
eautiful colored plates representing fifty-six 
chemical reactions. To say that they are splen- 
didly and artistically executed hardly does them 
justice. They must convey to the mind of the 
student lasting impressions of the color changes 
that he has noted in his experiments in the labor- 
atory, and the perusal of thi* work must recall 
them vividly to recognition. The many cuts are 
well selected, and the make-up of the book leaves 



nothing to be desired. As a student's manual this 
work is of the highest order.— The -Medical Neivs, 
February 20, 1892. 

While possessing all the usual qualities of an 
excellent text- book for the student or laboratory, 
this "Manual" presents the unique advantage of 
furnishing plates showing the variously shaded 
colors of certain chemicals, etc., and their re- 
actions. The chapter on Urinalysis is excellent. 
This "Chemittry" is especially valuable to medi- 
cal students and practitioners, as devoting so 
much of detail to descriptions of analyses, tests, 
etc., of those things with which the doctor has 
mostly to deal.— Virginia Medical 3Ionthly, Jan- 
uary, 1892. 



CLOWES, FRANK, JD. Sc, London, 

Senior Science- Master at the High School, Newcastle-under-Lyme, etc. 

An Elementary Treatise on Practical Chemistry and Qualitative 
Inorganic Analysis. Specially adapted for use in the Laboratories of Schools and 
Colleges and by Beginners. Third American from the fourth and revised English edition. 
In one 12mo. volume of 387 pages, with 55 illustrations. Cloth, $2.50. 



Lea Brothers & Co.'s Publications — Chemistry. 



FBANKLAND, E., 2>. C. L., F.B.S., &JAFF, F. B., F. I. C., 



Professor of Chemistry in the Normal School 
of Science, London. 



Assist. Prof, of Chemistry in the Normal 
School of Science, London. 



Inorganic Chemistry. In one handsome octavo volume of 677 pages with 51 
woodcuts and 2 plates. Cloth, $3.75 ; leather, $4.75. 

chemical knowledge is behind the times, would 
do well to study this work. The descriptions and 
demonstrations are made so plain that there is 
no difficulty in understanding them. — Cincinnati 
Medical News, January, 1886. 



This work should supersede other works of its 
class in the medical colleges. It is certainly better 
adapted than any work upon chemistry, with which 
we are acquainted, to impart that clear and full 
knowledge of the science which students of med- 
icine should have. Physicians who feel that their 



FOWNES, GEOBGE 9 Fh. D. 

A Manual of Elementary Chemistry; Theoretical and Practical. Em- 
bodying Watts' Physical and Inorganic Chemistry. New American, from the twelfth English 
edition. In one large royal 12mo. volume of 1061 pages, with 168 illustrations on wood 
and a colored plate. Cloth, $2.75 ; leather, $3.25. 



Fownes' CJiemistry has been a standard text- 
book upon chemistry for many years. Its merits 
are very fully known by chemists and physicians 
everywhere in this country and in England. As 
the science has advanced by the making of new 
discoveries, the work has been revised so as to 
keep it abreast of the times. It has steadily 
maintained its position as a text-book with medi- 
cal students. In this work are treated fully: Heat, 
Light and Electricity, including Magnetism. The 
influence exerted by these forces in chemical 
action upon health and disease, etc., is of the most 
important kind, and should be familiar to every 
medical practitioner. We can commend the 



work as one of the very best text-books upon 
chemistry extant.— Cincinnati Med. News, Oct. '85. 
Of all the works on chemistry intended for the 
use of medical students, Fownes' Chemistry is 
perhaps the most widely used. Its popularity is 
based upon its excellence. This last edition con- 
tains all of the material found in the previous, 
and it is also enriched by the addition of Watts' 
Physical and Inorganic Chemistry. All of the mat- 
ter is brought to the present standpoint of chemi- 
cal knowledge. We may safely predict for this 
work a continuance of the fame and favor it enjoys 
among medical students. — New Orleans Medical 
and Surgical Journal, March, 1886. 



ATTFIELD, JOHN, M. A., Flu D., F. I. C., F. B. S., Etc. 

Professor of Practical Chemistry to the Pharmaceutical Society of Ghreat Britain, etc. 

Chemistry, General, Medical and Pharmaceutical; Including the Chem- 
istry of the U. S. Pharmacopoeia. A Manual of the General Principles of the Science, 
and their Application to Medicine and Pharmacy. A new American, from the twelfth 
English edition, specially revised by the Author for America. In one handsome royal 
12mo. volume of 782 pages, with 88 illustrations. Cloth, $2.75 ; leather, $3.25. 

Attfield's Chemistry is the most popular book 
among students of medicine and phaimacy. This 
popularity has a good, substantial basis. It rests 
upon real merits. Attfield's work combines in the 
happiest manner a clear exposition of the theory 
of chemistry with the practical application of this 
knowledge to the everyday dealings of the phy- 
sician and pharmacist. His discernment is shown 
not only in what he puts into his work, but also in 
what he leaves out. His book is precisely what 
the title claims for it. The admirable arrangement 
of the text enables a reader to get a good idea of 
chemistry without the aid of experiments, and 



again it is a good laboratory guide, and finally it 
contains such a mass of well-arranged information 
that it will always serve as a handy book of refer- 
ence. He does not allow any unutilizable knowl- 
edge to slip into his book; his long years of 
experience have produced a work which is both 
scientific and practical, and which shuts out 
everything in the nature of a superfluity, and 
therein lies the secret of its success. This last 
edition shows the marks of the latest progress 
made in chemistry and chemical teaching. — New 
Orleans Medical and Surgical Journal, Nov. 1889. 



BLOXAM, CHABLES L., 

Professor of Chemistry in King's College, London. 

Chemistry, Inorganic and Organic. New American from the fifth Lon- 
don edition, thoroughly revised and much improved. In one very handsome octavo 
volume of 727 pages, with 292 illustrations. Cloth, $2.00 ; leather, $3.00. 

Comment from us on this standard work is al- complain that chemistry is a hard study. Much 
most superfluous. It differs widely in scope and attention is paid to experimental illustrations of 
aim from that of Attfield, and in its way is equally chemical principles and phenomena, and the 
beyond criticism. It adopts the most direct meth- mode of conducting these experiments. The book 
ods in stating the principles, hypotheses and facts maintains the position it has always held as one of 
of the science. Its language is so terse and lucid, the best manuals of general chemistry In the Eng- 
and its arrangement of matter so logical in se- lish language. — Detroit Lancet, Feb. 1884. 
quence that the student never has occasion to 



LUFF, ABTHUB F. 9 31. L>. 9 B. Sc, 

Lecturer on Medical Jurisprudence and Toxico 7 ogical Chemistry, St. Mary's Hospital Medical 
School, London. 
A Manual of Chemistry. For the use of students of medicine. In one 12mo. 
vol. of 522 pp., with 36 engravings. Cloth; $2.00. See Students' Series of Manuals, p. 30. 

GBEENE, WILLIAM JEE, 9 31. D. 9 

Demonstrator of Chemistry in the Medical Department of the University of Pennsylvania. 
A Manual of Medical Chemistry. For the use of Students. Based upon Bow- 
man's Medical Chemistry. In one 12mo. volume of 310 pages, with 74 illus. Cloth, $1.75. 

It is a concise manual of three hundred pages, I the recognition of compounds due to pathologica. 
giving an excellent summary of the best methods conditions. The detection of poisons is treated 
of analyzing the liquids and solids of the body, both with sufficient fulness for the purpose of the stu- 
for the estimation of their normal constituent and | dent or practitioner.— Boston Jl. of Chem. June '80. 



10 



Lea Brothers & Co.'s Publications — Chem., Pharm. 



VAUGMAW, VICTOR C, Ph. D., M. D. 9 

Prof, of Phys. and Path. Chem. and Assoc. Prof, of Therap. and Mat. Med. in the Univ. of Mich. 

and JSTOVY, FREDERICK G., M. D. 

Instructor in Hygiene and Phys. Chem. in the Univ. of Mich. 

Ptomaines, Leucomaines and Bacterial Proteids; or the Chemical 
Factors in the Causation of Disease. New (second) edition. In one handsome 
12mo. volume of 389 pages. Cloth, $2,25. 



The title of this volume brings prominently to 
view the correct pathology of a host of diseases. 
Modern chemistry has furnished no more striking 
evidence of its value than the discovery of these 
ultimate causes of disease, a step which neces- 
sarily precedes any rational knowledge of cure or 
Erevention. These successful methods of research 
ave also thrown a flood of light upon the Leuco- 
maines or Physiological Alkaloids. The literature 
of the subjects, already vast, was before the 
preparation of this work scattered and unattainable 



by those who had most need of its help, namely, 
general practitioners. For the student no more 
important branch of chemistry exists. The early 
demand for the second edition of a work on so 
new a department of science, augurs well for the 
curriculum in those colleges which have already 
made it a branch of study, and for the growing 
promptness on the part of the profession to recog- 
nize and use the most enlightened methods for 
the benefit of their patients.— The Southern Prac- 
titioner, December, 1891. 



REMSEN, IRA, M. !>., Ph. D., 

Professor of Chemistry in the Johns Hopkins University, Baltimore. 

Principles of Theoretical Chemistry, with special reference to the Constitu- 
tion of Chemical Compounds. Fourth and thoroughly revised edition. In one handsome 
royal 12mo. volume of 325 pages. Cloth, $2.00. Just ready. 

FROM THE PREFACE TO THE FOURTH EDITION. 

My object has been to help students to get clear ideas in regard to the foundations of 
chemistry. That the treatment has been regarded with favor is shown by the fact that 
four editions of the book have been demanded in a comparatively short time, and further 
by the fact that since the appearance of the last American edition it has been translated 
into German and Italian. I believe that all changes called for by the advance of the 
science have been made and that this edition will be found abreast of the times. The 
chief addition is a short chapter on Solutions. 

CHARLES, T. CRANSTOUIT, M. D., F. C. 8. 9 M. S., 

Formerly Asst. Prof, and Demonst. of Chemistry and Chemical Physics, Queen's College, Belfast. 

The Elements of Physiological and Pathological Chemistry. A 

Handbook for Medical Students and Practitioners. Containing a general account of 
Nutrition, Foods and Digestion, and the Chemistry of the Tissues, Organs, Secretions and 
Excretions of the Body in Health and in Disease. Together with the methods for pre- 
paring or separating their chief constituents, as also for their examination in detail, and 
an outline syllabus of a practical course of instruction for students. In one handsome octavo 
volume of 463 pages, with 38 woodcuts and 1 colored plate. Cloth, $3.50. 

Dr. Charles is fully impressed with the impor- 
tance and practical reach of his subject, and he 
has treated it in a competent and instructive man- 
ner. We cannot recommend a better book than 
the present. In fact, it fills a gap in medical text- 
books, and that is a thing which can rarely be said 



nowadays. Dr. Charles has devoted much space 
to the elucidation of urinary mysteries. He does 
this with much detail, and yet in a practical and 
intelligible manner. In fact, the author has filled 
his book with many practical hints.— Medical Rec- 
ord, December 20, 1884. 



HOFFMANN, F., A.M., Ph.D., & POWER, F.B., Ph.D., 

Public Analyst to the State of New York. Prof, of Anal. Chem. in the Phil. Coll. of Pharmacy. 

A Manual Of Chemical Analysis, as applied to the Examination of Medicinal 
Chemicals and their Preparations. Being a Guide for the Determination of their Identity 
and Quality, and for the Detection of Impurities and Adulterations. For the use of 
Pharmacists, Physicians, Druggists and Manufacturing Chemists, and Pharmaceutical and 
Medical Students. Third edition, entirely rewritten and much enlarged. In one very 
handsome octavo volume of 621 pages, with 179 illustrations. Cloth, $4.25. 

P ARRIS S, EDWARD, 

Late Professor of the Theory and Practice of Pharmacy in the Philadelphia College of Pharmacy. 
A Treatise on Pharmacy : Designed as a Text-book for the Student, and as a 
Guide for the Physician and Pharmaceutist. With many Formulae and Prescriptions. 
Fifth edition, thoroughly revised, by Thomas S. Wiegand, Ph. G. In one handsome 
octavo volume of 1093 pages, with 256 illustrations. Cloth, $5.00 ; leather, $6.00. 

ods of combination are concerned, can afford to 
leave this work out of the list of their works of 



No thorough-going pharmacist will fail to possess 
himself of so useful a guide to practice, and no 
physician who properly estimates the value of an 
accurate knowledge of the remedial agents em- 
ployed by him in daily practice, so far as their 
miscibility, compatibility and most effective meth- 



reference. The country practitioner, who must 
always be in a measure his own pharmacist, will 
find it indispensable. — Louisville Medical News, 
March 29, 1884. 



RALFE, CHARLES JET., M. D., F. R. C. P., 

Assistant Physician at the London Hospital. 
Clinical Chemistry. In one pocket-size 12mo. volume of 314 pages, with 16 
illustrations. Limp cloth, red edges, $1.50. See Students' Series of Manuals, page 30. 

LASSEN'S ELEMENTARY QUANTITATIVE I fessor of Chemistry in the Towne Scientific School, 
ANALYSIS. Translated, with notes and addi- University of Penna. In one 12mo. volume of 324 
tions, by Edgar P. Smith, Ph. D , Assistant Pro- | pages, with 36 illus. Cloth, $2.00. 



Lea Brothers & Co.'s Publications — Mat. Med., Therapeutics. 11 



STILLE 9 A., M.I>.,LL.I>., & MAISCH, J. M., JPhar. !>., 



Professor Emeritus of the Theory and Prac- 
tice of Medicine and of Clinical Medicine 
in the University of Pennsylvania. 



Prof, of Mat. Med. and Botany in Phila. 
College of Pharmacy, Sec'y to the Ameri- 
can Pharmaceutical Association. 



The National Dispensatory. 

CONTAINING THE NATURAL HISTORY, CHEMISTRY, PHARMACY, ACTIONS AND USES OF 

MEDICINES, INCLUDING THOSE RECOGNIZED IN THE PHARMACOPEIAS OF THE 

UNITED STATES, GREAT BRITAIN AND GERMANY, WITH NUMEROUS 

REFERENCES TO THE FRENCH CODEX. 

Fourth edition revised, and covering the new British Pharmacopoeia. In one mag- 
nificent imperial octavo volume of 1794 pages, with 311 elaborate engravings. Price 
in cloth, $7.25 ; leather, raised bands, $8.00 ; half Russia, $9.00. ^^*This work will be 
furnished with Patent Ready Reference Thumb-letter Index for $1.00 in addition to the price 
in any of the above styles of binding. 

It is with much pleasure that the fourth edition | discovery have received due attention. — Kansas 



of this magnificent work is received. The authors 
and publishers have reason to feel proud of this, 
the most comprehensive, elaborate and accurate 
work of the kind ever printed in this country. It 
is no wonder that it has become the standard au- 
thority for both the medical and pharmaceutical 
profession, and that four editions have been re- 
quired to supply the constant and increasing 
demand since its first appearance in 1879. The 
entire field has been gone over and the various 
articles revised in accordance with the latest 
developments regarding the attributes and thera- 
peutical action of drugs. The remedies of recent 



City Medical Index, Nov. 1887. 

We think it a matter for congratulation that the 
profession of medicine and that of pharmacy have 
shown such appreciation of this great work as to call 
for four editions within the comparatively brief 
period of eight years. The matters with which it 
deals are of so practical a nature that neither the 
physician nor the pharmacist can do without the 
latest text-books on them, especially those that are 
so accurate and comprehensive as this one. The 
book is in every way creditable both to the authors 
and to the publishers. — New York Medical Journal^ 
May 21, 1887. 



MAIS C JET, JOHJSTM., Bhar. D., 

Professor of Materia Medica and Botany in the Philadelphia College of Pharmacy. 

A Manual of Organic Materia Medica; Being a Guide to Materia Medica of 
the Vegetable and Animal Kingdoms. For the use of Students, Druggists, Pharmacists 
and Physicians. New (fifth) edition, thoroughly revised. In one very handsome 12mo. 
volume of 544 pages, with 270 engravings. Cloth, $3.00. Just ready. 

A notice of the previous edition is appended. 
For everyone interested in materia medica, fore his eyes. That it answers its purposes in this 
Maisch's Manual, first published in 1882, and now 
in its fourth edition, is an indispensable book. 
For the American pharmaceutical student it is 
the work which will give him the necessary knowl- 
edge in the easiest way, partly because the text is 
brief, concise, and free from unnecessary matter, 
and partly because of the numerous illustrations, 
which bring facts worth knowing immediately be- 



respect the rapid succession of editions is the best 
evidence. It is the favorite book of the Ameiiean 
student even outside of Maisch's several hundred 
personal students. The arrangement of its con- 
tents shows the practical tendency of the book. 
Maisch's system of classification is easy and com- 
prehensive. — Pharmaceutische Zeitung, Germany, 
1890. 



EDES, BOBEBT T., M. D. 9 

Jackson Professor of Clinical Medicine in Harvard University, Medical Department. 

A Text-Book of Therapeutics and Materia Medica. Intended for the 
Use of Students and Practitioners. Octavo, 544 pages. Cloth, $3.50 ; leather, $4.50. 

on having produced so good a one.— N. Y. Medical 



It possesses all the essentials which we expect 
in a book of its kind, such as conciseness, clear- 
ness, a judicious classification, and a reason- 
able degree of dogmatism. All the newest drugs 
of promise are treated of. The clinical index at 
the end will be found very useful. We heartily 
commend the book and congratulate the author 



Journal, Feb. 18, 

Dr. Edes' book represents better than any older 
book the practical therapeutics of the present 
day. The book is a thoroughly practical one. The 
classification of remedies has reference to their 
therapeutic action.— Pharmaceutical Era, Jan. 1888. 



BBUCE, J. MITCHELL, M. !>., F. B. C. B., 

Physician and Lecturer on Materia Medica and Therapeutics at Charing Cross Hospital, London. 
Materia Medica and Therapeutics. An Introduction to Rational Treatment. 
Fifth edition. 12mo., 591 pages. Cloth, $1.50. See Students 1 Series of Manuals, page 30. 

GBIFFITH, BOBEBT EGLESFIELB, M. D. 

A Universal Formulary, containing the Methods of Preparing and Adminis- 
tering Officinal and other Medicines. The whole adapted to Physicians and Pharmaceut- 
ists. Third edition, thoroughly revised, with numerous additions, by John M. Maisch, 
Phar. D., Professor of Materia Medica and Botany in the Philadelphia College of Pharmacy. 
In one octavo volume of 775 pages, with 38 illustrations. Cloth, $4.50 ; leather, $5.50. 



HERMANN'S EXPERIMENTAL PHARMACOL- 
OGY. A Handbook of Methods for Determining 
the Physiological Action of Drugs. Translated, 
with the Author's permission, and with exten- 
sive additions, by R. M. Smith, M. D. 12mo., 
199 pages, with 32 illustrations. Cloth, §1.50. 



TILLE'S THERAPEUTICS AND MATERIA 
MEDICA. A Systematia Treatise on the Action 
and Uses of Medicinal Agents, including their 
Description and History. Fourth edition, re- 
vised and enlarged. In two octavo volumes, con- 
taining 1936 pages. Cloth, $10.00 ; leather, $12.00. 



12 



Lea Brothers & Co.'s Publications— Mat. Med., Therapeutics. 



A SYSTEM OF PRACTICAL THERAPEUTICS 

BY AMERICAN AND FOREIGN AUTHORS. 

Edited by HOBART AMORY HARE, M. D., 

Professor of Therapeutics and Materia Medica in the Jefferson Medical College of Philadelphia. 

Assisted by Walter Chrystie, M. D., Formerly Instructor in Physical 
Diagnosis in the University of Penna. 
In a series of contributions by seventy-eight eminent authorities. In three laro-e 
octavo volumes of about 1100 pages each, with illustrations. Vols. I.. II and III just 
ready. ^ Price, per volume: Cloth, $5.00; leather, $6.00; half Russia, $7.00. For sale by 
subscription only. Address the Publishers. Full prospectus free to any address on application. 

In our notices of the two preceding volumes 
of this magnificent work we spoke highly of its 
merits as an encyclopedic reference book, and 
commended it to the profession as the most per- 
fect work of the kind. The third volume has 






already appeared, following the other two in an 
almost incredibly short time, and in every respect 
the equal of its predecessors. We feel that we 
cannot say too much for this System. It is exactly 
what the practitioner needs for daily reference. 
All diseases are treated of in their etiology, 
pathology and symptomatology, and the applica- 
tion of medicines to their management fully 
given. Every subject is handled by a writer who 
has devoted himself especially to its considera- 
tion, so that the system is really a collection of 
monographs by writers who are authorities upon 
the subjects. In the list of authors, of which 
their are forty for this volume, we observe the 
names of some of the best-known American 
physicians, who have distinguished themselves by 
their works or their writings in the special depart- 
ments in which they have labored. No one who 
desires to keep in the van of professional advance 
can afford to be without it. We unhesitatingly 
commend it as a most valuable contribution to 



the medical literature of the day— Nashville Jour- 
nal of Medicine and Surgery, July, 1892. 

The scope of this work" is beyond that of any 
previous one on the subject. The goal, after all,, 
is the treatment of disease, and a work which con- 
tributes to its successful management is to be 
looked upon as of vast use to humanity. It can- 
not be denied that therapeutic resources, whether 
the treatment be confined to the mere administra- 
tion of drugs, or allowed its more extended appli- 
cation to the management of disease, have so 
greatly multiplied within the last few years as to 
render previous treatises of little value. Herein 
will be found the great value of fare's encyclo- 
pedic work, which groups together within a single 
series of volumes the most modern methods 
known in the management of disease, and espe- 
cially deals with important subjects comprehen- 
sively, which could not be done in a more limited 
treatise. We cannot commend Hare's System 
of Practical Therapeutics too highly; it stands 
out first and foremost as a work to be consulted 
by authors, teachers, and physicians, throughout 
the world. — Buffalo Medical aud Surgical Journal. 
August, 1892. 



HARE, SOB ART AMORY, B. Sc, M. Z>., 

Professor of Materia Medica and Therapeutics in the Jefferson Medical. College of Philadelphia; 
Secretary of the Convention for the Revision of the United States Pharmacopoeia of 1890. 

A Text-Book of Practical Therapeutics ; With Especial Reference to the 
Application of Remedial Measures to Disease and their Employment upon a Rational 
Basis. With special chapters by Drs. G. E. de Schweinitz, Edward Martin, 
J. Howard Reeves and Barton C. Hirst. New (2d) and revised edition. In one 
handsome octavo volume of 650 pages. Cloth, $3.75 ; leather, $4.75. 



This work has received the rare distinction 
among medical works of reaching a second edition 
six months after its first appearance. Many new 
prescriptions have also been inserted to illustrate 
the best modes of applying remedies. Among 
other features of this practically helpful treatise 
which will make reference to it convenient and 
profitable, are the arrangement of titles of drugs 



and diseases in alphabetical order, according to 
their English names; and a dose list of drugs 
officinal and unofficinal. In addition to the gen- 
eral index, a copious and explanatory index of 
diseases and remedies has been appended which 
will render the contents easily accessible. — The 
Medical Age, July 10, 1891. 



BRTJWTON, T. LAUDER, M.D., JD.Sc, E.R.S., F.R.C.JP., 

Lecturer on Materia Medica and Therapeutics at St. Bartholomew's Hospital, London, etc. 

A Text-Book of Pharmacology, Therapeutics and Materia Medica j 

Including the Pharmacy, the Physiological Action and the Therapeutical Uses of Drugs. 
Adapted to the U. S. Pharmacopoeia by Francis H. Williams, M.D., of Harvard Univer- 
sity Medical School. Third edition. Octavo, 1305 pages, 230 illustrations. Cloth, $5.50; 
leather, $6.50. 



No words of praise are needed for this work, for 
it has already spoken for itself in former editions. 
It was by unanimous consent placed among the 
foremost books on the subject ever published in 
any language, and the better it is known and studied 
the more highly it is appreciated. The present 
edition contains much new matter, the insertion 
of which has been necessitated by the advances 



made in various directions in the art of therapeu- 
tics, and it now stands unrivalled in its thoroughly 
scientific presentation of the modes of drug action. 
No one who wishes to be fully up to the times in 
this science can afford to neglect the study of Dr. 
Brunton's work. The indexes are excellent, and 
add not a little to the practical value of the book. 
—Medical Record, May 25, 1889. 



EARQUHARSOJT, ROBERT, M. !>., F. R. C. JP., LL. D., 

Lecturer on Materia Medica at St. Mary's Hospital Medical School, London. 

A Guide to Therapeutics and Materia Medica. Fourth American, 
from the fourth English edition. Enlarged and adapted to the U. S. Pharmacopoeia. By 
Frank Woodbury, M. D., Professor of Materia Medica and Therapeutics and Clinical 
Medicine in the Medico- Chirurgical College of Philadelphia. In one handsome 12mo. 
volume of 581 pages. Cloth, $2.50. 

copoeias, as well as considering all non-official but 
important new drugs, it becomes in fact a miniature 
dispensatory. — Pacific Medical Journal, June, 1889. 



It may correctly be regarded as the most modern 
work of its kind. It is concise, yet complete. 



Containing an account of all remedies that have 
a place in the British and United States Pharma- 



Lea Brothers & Co.'s Publications — Practice of Med. 



13 



FLINT, AUSTIN, M. JD. 9 LI. D., 

Prof, of the Principles and Practice of Med. and of Clin. Med. in Bellevue Hospital Medical College, N. Y. 

A Treatise on the Principles and Practice of Medicine. Designed for 
the use of Students and Practitioners of Medicine. Sixth edition, thoroughly revised 
and rewritten by the Author, assisted by William H. Welch, M. D., Professor of 
Pathology, Johns Hopkins University, Baltimore, and Austin Flint, Jr., M. D., LL. D., 
Professor of Physiology, Bellevue Hospital Medical College, N. Y. In one very handsome 
octavo volume of 1160 pages, with illustrations. Cloth, $5.50 ; leather, $6.50. 



No text-book on the principles and practice of 
medicine has ever met in this country with such 
general approval by medical students and practi- 
tioners as the work of Professor Flint. In all*the 
medical colleges of the United States it is the fa- 
vorite work upon Practice; and, as we have stated 
before in alluding to it, there is no other medical 
work that can be so generally found in the libra- 
ries of physicians. In every state and territory 
of this vast country the book that will be most likely 
to be found in the office of a medical man, whether 



in city, town, village, or at some cross-roads, is 
Flint's Practice. We make this statement to a 
considerable extent from personal observation, and 
it is the testimony also of others. An examina- 
tion shows that very considerable changes have 
been made in the sixth edition. The work may un- 
doubtedly be regarded as fairly representing the 
present state of the science of medicine, and as 
reflecting the views of those who exemplify in 
their practice the present stage of progress of med- 
ical art.— Cincinnati Medical Newt, Oct. 1886. 



BBISTOWE, JOHN STUB, 

Senior Physician to and Lecturer on Medicine 

A Treatise on the Science and 
tion. In one large octavo volume of 1325 

Dr. Bristowe's now famous treatise appears in 
its seventh edition. It has long passed the stage 
in which it requires critical examination or com- 
mendation, and has thoroughly established itself 
as among the most complete and useful of text- 
books.— British Medical Journal, September 27, 1890. 

It is a work that is built on a stable founda- 



M. JD., LL. &., F. B. S., 

at St. Thomas' Hospital, London. 

Practice of Medicine. Seventh edi- 

Cloth, $6.50 ; leather, $7.50. 
tion, systematic, scientific and practical, contain- 
ing the matured experience of a physician who 
has every claim to be considered an authority, 
and composed in a style which attracts the prac- 
titioner as much as the student. No one can say 
that this book has obtained a success which was 
undeserved.— The Lancet, July 12, 1890. 



HABTSHOBNE, HENBY, II. !>., LL. I)., 

Lately Professor of Hygiene in the University of Pennsylvania. 

Essentials of the Principles and Practice of Medicine. A Handbook 
for Students and Practitioners. Fifth edition, thoroughly revised and rewritten. In one 
royal 12mo. volume of 669 pages, with 144 illustrations. Cloth, $2.75. 

a better average of actual practical treatment than 
this one; and probably not one writer in our day 
had a better opportunity than Dr. Hartshorne for 
condensing all the views of eminent practitioners 
into a 12mo. The numerous illustrations will be 



Within the compass of 600 pages it treats of the 
history of medicine, general pathology, general 
symptomatology, and physical diagnosis (including 
laryngoscope, ophthalmoscope, etc.), general ther- 
apeutics, nosology, and special pathology and prac- 
tice. There is a wonderful amount of information 
contained in this work, and it is one of the best 
of its kind that we have seen. — Glasgow Medical 
Journal, Nov. 1882. 

An indispensable book. No work ever exhibited 



very useful to students especially. These essen- 
tials are most valuable in affording the means to 
see at a glance the whole literature of any disease, 
and the most valuable treatment.— Chicago Medical 
Journal and Examiner, April, 1882. ^^ 



BEYNOLJDS, J. BUSSELL, M. !>., 

Professor of the Principles and Practice of Medicine in University College, London. 
A System of Medicine. With notes and additions by Henr? Hartshorne, 
A. M., M. D., late Professor of Hygiene in the University of Pennsylvania. In three large 
and handsome octavo volumes, containing 3056 double-columned pages, with 317 illustra- 
tions. Price per volume, cloth, $5.00; sheep, $6.00; half Russia, raised bands, $6.50. 
Per set, cloth, $15.00; leather, $18.00; half Russia, $19.50. Sold only by subscription. 



COHEN, SOLOMON SOLIS, M. JO., 

Professor of Clinical Medicine and Applied Therapeutics in the Philadelphia Polyclinic. 

A Handbook of Applied Therapeutics. Being a Study of Principles 
Applicable and an Exposition of Methods Employed in the Management of the Sick. 
In one large 12mo. volume, with illustrations. Preparing. 



STTLLE ON CHOLERA: Its Origin, History, 
Causation, Symptoms, Lesions, Prevention and 
Treatment. In one handsome 12mo. volume of 
163 pages, with a chart. Cloth, $1.25. 

WATSONS LECTURES ON THE PRINCIPLES 
AND PRACTICE OF PHYSIC. From the fifth 
English edition. Edited with additions, and 190 
illustrations, by Hi^-ry Hartshorne, A.M., M. D., 
late Professor of Hygiene in the University of 
Pennsylvania. In two large octavo volumes of 
1840 pages. Cloth, §9.00; leather, $11. 00. 

FLINT ON PHTHISIS: ITS MORBID ANAT- 
OMY, ETIOLOGY, SYMPTOMATIC EVENTS 



AND COMPLICATIONS, FATALITY AND 
PROGNOSIS, TREATMENT AND PHYSICAL 
DIAGNOSIS; in a series of Clinical Studies. In 
one octavo volume of 442 pages. Cloth, $3.50. 

FLINT'S PRACTICAL TREATISE ON THE 
DIAGNOSIS, PATHOLOGY AND TREATMENT 
OF DISEASES OF THE HEART. Second re- 
vised and enlarged edition. In one octavo vol- 
ume of 550 pages, with a plate. Cloth, $4. 

FLINT'S ESSAYS ON CONSERVATIVE MEDI- 
CINE AND KINDRED TOPICS. In one very 
handsome royal 12mo. volume of 210 pages 
Cloth, $1.38. 



14 



Lea Brothers & Co.'s Publications — System of Med, 



For Sale by Subscription Only, 



A System of Practical Medicine. 

BY AMERICAN AUTHORS. 
Edited by WILLIAM PEPPER, M. D., LL. D., 

PROVOST AND PROFESSOR OF THE THEORY AND PRACTICE OF MEDICINE AND OF 
CLINICAL MEDICINE IN THE UNIVERSITY OF PENNSYLVANIA, 

Assisted by Louis Starr, M. D., Clinical Professor of the Diseases of Children in the 
Hospital of the University of Pennsylvania. 

The complete work, in five volumes, containing 5573 pages, with 198 illustrations, is now ready. 
Price per volume, cloth, $5; leather, $6 ; half Russia, raised bands and open back, $7. 



In this great work American medicine is for the first time reflected by its worthiest 
teachers, and presented in the fall development of the practical utility which is its pre- 
eminent characteristic. The most able men — from the East and the West, from the 
North and the South, from all the prominent centres of education, and from all the 
hospitals which afford special opportunities for study and practice — have united in 
generous rivalry to bring together this vast aggregate of specialized experience. 

The distinguished editor has so apportioned the work that to each author has been 
assigned the subject which he is peculiarly fitted to discuss, and in which his views 
will be accepted as the latest expression of scientific and practical knowledge. The 
practitioner will therefore find these volumes a complete, authoritative and unfailing work 
of reference, to which he may at all times turn with full certainty of finding what he needs 
in its most recent aspect, whether he seeks information on the general principles of medi- 
cine, or minute guidance in the treatment of special disease. So wide is the scope of the 
work that, with the exception of midwifery and matters strictly surgical, it embraces the 
whole domain of medicine, including the departments for which the physician is accustomed 
to rely on special treatises, such as diseases of women and children, of the genito-urinary 
organs, of the skin, of the nerves, hygiene and sanitary science, and medical ophthalmology 
and otology. Moreover, authors have inserted the formulas which they have found most 
efficient in the treatment of the various affections. It may thus be truly regarded as a 
Complete Library of Practical Medicine, and the general practitioner possessing it 
may feel secure that he will require little else in the daily round of professional duties. 

In spite of every effort to condense the vast amount of practical information fur- 
nished, it has been impossible to present it in less than 5 large octavo volumes, containing 
about 5600 beautifully printed pages, and embodying the matter of about 15 ordinary 
octavos. Illustrations are introduced wherever requisite to elucidate the text. 

A detailed prospectus will be sent to any address on application to the publishers. 

These two volumes bring this admirable work 
to a close, and fully sustain the high standard 
reached by the earlier volumes; we have only 
therefore to echo the eulogium pronounced upon 
them. We would warmly congratulate the editor 
and his collaborators at the conclusion of their 
laborious task on the admirable manner in which. 
from first to last, they have performed their several 
duties. They have succeeded in producing a 
work which will long remain a standard work of 
reference, to which practitioners will look for 
guidance, and authors will resort for facts. 
From a literary point of view, the work is without 
any serious blemish, and in respect of production, 
it has the beautiful finish that Americans always 
give their works. — Edinburgh Medical Journal, Jan. 
1887. 

* * The greatest distinctively American work on 
the practice of medicine, and, indeed, the super- 
lative adjective would not be inappropriate were 
even all other productions placed in comparison. 
An examination of the five volumes is sufficient 
to convince one of the magnitude of the enter- 
prise, and of the success which has attended its 
fulfilment.— The Medical Age, July 26, 1886. 

This huge volume forms a fitting close to the 
great system of medicine which in so short a time 
has won so high a place in medical literature, and 
has done such credit to the profession in this 
country. Among the twenty-three contributors 
are the names of the leading neurolosists in 
America, and most of the work in the volume is of 
the highest order.— Boston Medical and Surgical 
Journal, July 21, 1887. 

"We consider it one of the grandest works on 
Practical Medicine in the English language. It is 
a work of which the profession of this country can 
feel proud. Written exclusively by American 



physicians who are acquainted with all the varie- 
ties of climate in the United States, the character 
of the soil, the manners and customs of the peo- 
ple, etc., it is peculiarly adapted to the wants 
of American practitioners of medicine, and it 
seems to us that every one of them would desire 
to have it. It has been truly called a "Complete 
Library of Practical Medicine," and the general 
practitioner will require little else in his round 
of professional duties.— Cincinnati Medical News, 
March, 1886. 

Each of the volumes is provided with a most 
copious index, and the work altogether promises 
to be one which will add much to the medical 
literature of the present century, and reflect great 
credit upon the scholarship and practical acumen 
of its authors. — The London Lancet, Oct. 3, 1885. 

The feeling of proud satisfaction with which the 
American profession sees this, its representative 
syste.m of practical medicine issued to the medi- 
cal world, is fully justified by the character of the 
work. The entire caste of the system is in keep- 
ing with the best thoughts of the leaders and fol- 
lowers of our home school of medicine, and the 
combination of the scientific study of disease and 
the practical application of exact and experimen- 
tal knowledge to the treatment of human mal- 
adies, makes every one of us share in the pride 
that has welcomed Dr. Pepper's labors. Sheared 
of the prolixity that wearies the readers of the 
German school, the articles glean these same 
fields for all that is valuable. It is the outcome 
of American brains, and is marked throughout 
by much of the sturdy independence of thought 
and originality that is a national characteristic. 
Yet nowhere is there lack of study of the most 
advanced views of the day. — North Carolina Medi- 
cal Journal, Sept. 1886. 



Lea Brothers & Co.'s Publications — Practice of Medicine. 15 



LYMAN, HENRY M., M. L>., 

Professor of the Principles and Practice of Medicine, Rush Medical College, Chicago. 

The Principles and Practice of Medicine. For the Use of Medical Students 
and Practitioners. In one very handsome octavo volume of 925 pages, with 170 illustra- 
tions. Cloth, $4.75 ; leather, $5.75. Just ready. 

The author has undertaken to present in this volume not only the results of his long 
experience as a practitioner and teacher, but to make it representative of the latest state 
of knowledge in its department. The work is assured of wide use as an unsurpassed guide 
for the student and likewise for the practitioner. 

WHITLA, WILLIAM, M. JD., 

Projessor of Materia Medica and Therapeutics in the Queen's College, Belfast. 

A Dictionary of Treatment ; or Therapeutic Index, including Medi- 
cal and Surgical Therapeutics. Eevised and adapted to the United States 
Pharmacopoeia. In one square, octavo volume of 917 pages. Cloth, $4.00. Just ready. 



Dr. Whitla has, we think, been fortunate in the 
selection of a title for his latest work. We have 
already dictionaries of medicine and dictionaries 
of surgery; he now provides us with a dictionary 
of treament. And reference to the volume shows 
that it really is what it professes to be. The sev- 
eral diseased ccnditions are arranged in alphabet- 
ical order, and the methods — medical, surgical, 
dietetic, and climatic— by which they may be met, 
considered. On every paee we find clear and de- 
tailed directions for treatment, supported by the 
author's personal authority and experience, whilst 
the recommendations of other com petentobservers 
are also critically examined. The book abounds 
with useful, practical hints and suggestions, and 



the younger practitioner will find in it exactly the 
help he so often needs in the treatment both of 
those who are ill, and those who are ailing. At the 
same time the most experienced members of the 
profession may usefully consult its pages for the 
purpose of learning what is really trustworthy in 
the later therapeutic developments. The Diction- 
ary is, in short, the recorded experience of a prac- 
tical scientific therapeutist, who has carefully 
studied diseases and disorders at the bed-side and 
in the consulting-room, and has earnestly ad- 
dressed himself to the cure and relief of his 
patients. Dr. Whitla is to be congratulated upon 
the thoroughness with which he has realised his 
idea. — The Glasgow Medical Journal, April, 1892. 



FOTHERGILL, J. M., M. !>., Edin., M. R. C. P., Lond., 

Physician to the City of London Hospital fo^ Diseases of the Chest. 

The Practitioner's Handbook of Treatment ; Or, The Principles of Thera- 
peutics. Third edition. In one 8vo. vol. of 661 pages. Cloth, $3.75 ; leather, $4.75. 



To have a description of the normal physiologi- 
cal processes of an organ and of the methods of 
treatment of its morbid conditions brought 
together in a single chapter, and the relations 
between the two clearly stated, cannot fail to prove 



This is a wonderful book. If there be such a 
thing as "medicine made easy," this is the work to 
accomplish this result. — Va. Med. Month., June,'87. 

It is an excellent, practical work on therapeutics, 
well arranged and clearly expressed, useful to the 



great convenience to many thoughtful but busy student and young practitioner, perhaps even to 



physicians. The practical value of the volume is 
greatly increased by the introduction of many 
prescriptions. That the profession appreciates 
that the author has undertaken an important work 
and has accomplished it is shown by the demand 
for this third edition.— N. Y. Med. Jour., June 11,'87. 



the old. — Dublin Journal of Medical Science, March, 
1888. 

We do not know a more readable, practical and 
useful work on the treatment of disease than the 
one we have now before us. — Pacific Medical and 
Surgical Journal, October, 1887. 



FINLAYSON, JAMES, M. L>., Editor, 

Physician and Lecturer on Clinical Medicine in the Glasgow Western Infirmary, etc. 

Clinical Manual for the Study of Medical Cases. With Chapters 
by Prof. Gairdner, Prof. Stephenson, Dr. Robertson, Dr. Gemmell and Dr. Coats. Second 
edition. In one 12mo. volume of 682 pages, with 158 illustrations. Cloth, $2.50. 

has no competitor, nor is it likely to have as long 
as future editions maintain its present standard of 
excellence. The general practitioner will find 
many practical hints in its pages, while a careful 
study of the work will save him from many pitfalls 
in diagnosis. — Liverpool Medico- Chirurgical Jour- 
nal, January, 1887. 



We are pleased to see a second edition of this 
admirable book. It is essentially a practical 
treatise on medical diagnosis, in which every sign 
and symptom of disease is carefully analyzed, and 
their relative significance in the different affec- 
tions in which they occur pointed out. From their 
synthesis the student can accurately determine 
the disease with which he has to deal. The book 



MUSS EH, JOHN H. 9 M. D., 

Assistant Professor of Clinical Medicine, University of Pennsylvania, Philadelphia. 

A Practical Treatise on Medical Diagnosis, For the Use of Students and 
Practitioners. In one octavo volume of about 650 pages. Preparing. 

HABERSHON, S. O., M. !>., 

Senior Physician to and late Led. on Principles and Practice of Med. at Guy's Hospital, London. 

On the Diseases of the Abdomen ; Comprising those of the Stomach, and 
other parts of the Alimentary Canal, (Esophagus, Caecum, Intestines and Peritoneum. Second 
American from third enlarged and revised English edition. In one handsome octavo 
volume of 554 pages, with illustrations. Cloth, $3.50. 



This valuable treatise on diseases of the stomach 
and abdomen will be found a cyclopaedia of infor- 
mation, systematically arranged, on all diseases of 
the alimentary tract, from the mouth to the 



rectum. A fair proportion of each chapter is 
devoted to symptoms, pathology, and therapeutics. 
—New York Medical Journal, April, 1879. 



TANNER'S MANUAL OF CLINICAL MEDICINE 
AND PHYSICAL DIAGNOSIS. Third American 
from the second London edition. Revised and 
enlarged by Tilbury Fox, M.D. In one 12mo. 
volume of 362 pp ., with illus. Cloth, $1.50. 

A TREATISE ON FEVER. By Robert D. Lyons, 
K. C. C. In one 8vo. vol. of 354 pp. Cloth, $2.25. 



LECTURES DN THE STUDY OF FEVER. By 
A. Hudson , M. D., M. R. I. A. In one octavo 
volume of 308 pages. Cloth, $2.50. 

LA ROCHE ON YELLOW FEVER, considered in 
its Historical, Pathological, Etiological and 
Therapeutical Relations. In two large and hand- 
some octavo volumes of 1468 pp. Cloth, $7.00. 



16 Lea Brothers & Co.'s Publications — Hygiene, Electr., Pract. 



BARTHOLOW, ROBERTS. A. M., M. JD., LL. D. 9 

Prof, of Materia Medica and General Therapeutics in the Jefferson Med. Coll. of Phila., etc. 
Medical Electricity^ A Practical Treatise on the Applications of Electricity 



to Medicine and Surgery. Third edition, 
pages, with 110 illustrations. Cloth, $2.50. 

The fact that this work has reached its third edi- 
tion in six years, and that it has been kept fully 
abreast with the increasing use and knowledge of 
electricity,demonstrates its claim to be considered 
a practical treatise of tried value to the profession. 
Tne matter added to the present edition embraces 



In one very handsome octavo volume of 303 



the most recent advances in electrical treatment. 
The illustrations are abundant and clear, and the 
work constitutes a full, clear and concise manual 
well adapted to the needs of both student and 
practitioner.— The Medical News, May 14, 1887. 



YEO, I. BURNEY, M. H., F. R. C. P., 

Professor of Clinical Therapeutics in King's College, London, and Physician to King's College 
Hospital. 

Food in Health and Disease. In one 12mo. volume of 590 pages. Cloth, $2. 
See Series of Clinical Manuals, page 31. 



Dr.Yeo supplies in a compact form nearly all that 
the practitioner requires to know on the subject of 
diet. The work is divided into two parts — food in 
health and food in disease. Dr. Yeo has gathered 
together from all quarters an immense amount of 
useful information within a comparatively small 



compass, and he has arranged and digested his 
materials with skill for the use of the practitioner. 
We have seldom seen a book which more thor- 
oughly realizes the object for which it was written 
than this little work of Dr. Yeo.— British Medical 
Journal, Feb. 8, 1890. 



RICHARDSON, B. W., M.D., LL. D., F.R.S., 

Fellow of the Royal College of Physicians, London. 
Preventive Medicine. In one octavo volume of 729 pages. Cloth, $4; leather, $5. 

tive collection of data upon the diseases common 



Dr. Richardson has succeeded in producing a 
work which is elevated in conception, comprehen- 
sive in scope, scientific in character, systematic in 
arrangement, and which is written in a clear, con- 
cise and pleasant manner. He evinces the happy 
faculty of extracting the pith of what is known on 
the subject, and of presenting it in a most simple, 
intelligent and practical form. There is perhaps 
no similar work written for the general public 
thatcontains such a complete, reliable and instruc- 



to the race, their origins, causes, and the measures 
for their prevention. The descriptions of diseases 
are clear, chaste and scholarly; the discussion of 
the question of disease is comprehensive, masterly 
and fully abreast with the latest and best knowl- 
edge on the subject, and the preventive measures 
advised are accurate, explicit and reliable.— The 
American Journal of the Medical Sciences, April, 1884. 



THE YEAB BOOK OF TREATMENT FOB 1892. 

A Comprehensive and Critical Review for Practitioners of Medi- 
cine and Surgery. In one 12mo. vol. of about 500 pages. Cloth, $1.50. 
x\ For special commutations with periodicals see pages 1 and 2. 



The "Year-Book" is too well known and too 
highly appreciated to need comment. The lm 
mense strides taken in the progress of medicine 
in all its branches make it impossible for anyone 
to keep up with the times. Hence the necessity 
of the book in hand. Its score of co-authors sift 
out what is useful in literature and present it in a 



concise and readable form. Thus, with compara- 
tively little labor, the busy practitioner gets the 
gist of medical literature the world over. Every 
branch of medicine is covered— new remedies, old 
ones with new applications, new operations, all 
receiving attention. — Meaical Record, May 21, 1892. 



THE YEAR-BOOK OF TREATMENT FOR 1891. 

12mo., 485 pages. Cloth, $1.50. 

THE YEAR-BOOKS of TREATMENT for '86, '87 and '90 

Similar to above. 12mo., 320-341 pages. Limp cloth, $1.25 each. 

SCHREIBER, JOSEPH, M. JO. 

A Manual of Treatment by Massage and Methodical Muscle Ex- 
ercise. Translated by Walter Mendelson, M. D., of New York. In one handsome 
octavo volume of 274 pages, with 117 fine engravings. 

STURGES' INTRODUCTION TO THE STUDY 
OF CLINICAL MEDICINE. Being a Guide to 
the Investigation of Disease. In one handsome 
12mo. volume of 127 pages. Cloth, $1.25. 

DAVIS' CLINICAL LECTURES ON VARIOUS 
IMPORTANT DISEASES. By N. S. Davis. 
M. D. Edited by Frank H. Davis, M. D. Second 
edition. 12mo. 287 pages. Cloth, $1.75. 

TODD'S CLINICAL LECTURES ON CERTAIN 
ACUTE DISEASES. In one octavo volume of 
320 pages. Cloth, $2.50. 

PAVY'S TREATISE ON THE FUNCTION OF DI- 
GESTION; its Disorders and their Treatment. 
From the second London edition. In one octavo 
volume of 238 pages. Cloth, $2.00. 

BARLOW'S MANUAL OF THE PRACTICE OF 

MEDICINE. With additions by D. F. Condie, 
M.D. 1 vol. 8 vo., pp. 603. Cloth, $2.50. 
CHAMBERS' MANUAL OF DIET AND REGIMEN 
IN HEALTH AND SICKNESS. In one hand 
some octavo volume of 302 pp. Cloth, $2.75. 



HOLLAND'S MEDICAL NOTES AND REFLEC- 
TIONS. 1 vol. 8vo., pp. 493. Cloth, $3.50. 

FULLER ON DISEASES OF THE LUNGS AND 
AIR-PASSAGES. Their Pathology, Physical Di- 
agnosis, Symptoms and Treatment. From the 
second and revised English edition. In one 
octavo volume of 475 pages. Cloth, $3.50. 

WALSHE ON THE DISEASES OF THE HEART 
AND GREAT VESSELS. Third American edi- 
tion. In 1 vol. 8vo., 416 pp. Cloth, $3.00. 

SLADE ON DIPHTHERIA; its Nature and Treat- 
ment, with an account of the History of its Pre- 
valence in various Countries. Second and revised 
edition. In one 12mo. vol., 158 pp. Cloth, $1.25. 

SMITH ON CONSUMPTION ; its Early and Reme- 
diable Stages. 1 vol. 8vo., 253 pp. Cloth, $2.25. 

LA ROCHE ON PNEUMONIA. 1 vol. 8vo. of 490 
pages. Cloth, $3.00. 

WILLIAMS ON PULMONARY CONSUMPTION; 
its Nature, Varieties and Treatment. With an 
analysis of one thousand cases to exemplify its 
duration. In one 8vo. vol. of 303 pp. Cloth, $2.50. 



Lea Brothers & Co.'s Publications — Phys. Diag-., Throat, Hist. 17 
FLIJTT, AUSTIN, M. !>., LL. !>., 

Professor of the Principles and Practice of Medicine in Bellevue Hospital Medical College, N. T. 

A. Manual of Auscultation and Percussion ; Of the Physical Diagnosis of 
Diseases of the Lungs and Heart, and of Thoracic Aneurism. Fifth edition. 
Edited by James C. Wilson, M. D., Lecturer on Physical Diagnosis in the Jefferson 
Medical College, Philadelphia. In one handsome royal 12mo. volume of 274 pages, with 
12 illustrations. Cloth, $1.75. 

This little book through its various editions has 
probably done more to advance the science of 
physical exploration of the chest than any other 
dissertation upon the subject, and now in its fifth 
edition it is as near perfect as it can be. The 
rapidity with which previous editions were sold 
shows how the profession appreciated the thor- 



oughness of Prof. Flint's investigations. For stu- 
dents it is excellent. Its value is shown both in 
the arrangement of the material and in the clear, 
concise style of expression. For the practitioner 
it is a ready manual for reference.— North Ameri- 
can Practitioner, January, 1891. 



BBOADBFNT, W. H., M. !>., F. B. C. P., 

Physician to and Lecturer on Medicine at St. Mary's Hospital, London. 
The Pulse. In one 12mo. volume of 312 pages. Cloth, $1.75. 
ical Manuals, page 31. 



See Series of Clin- 



BBOWNE, LENNOX, F. B. C. 8., F., 

Senior Physician to the Central London Throat and Ear Hospital. 

The Throat and Nose and Their Diseases. Fourth and enlarged edition. 
In one imperial octavo volume of about 750 pages, with 120 illustrations in color, and 235 
engravings on wood. Preparing. 

A notice of the previous edition is appended. 

The beautiful and typical colored plates form I tical text-book on diseases of the throat and nose 
a valuable and instructive atlas, the equal of which extant. We are glad to learn that it is being 
is not to be found in any modern work, treating j translated into French and German. — The Provin- 
of these subjects. Mr. Lennox Browne is to be i cial Medical Journal, August 1, 1890. 
congratulated on having produced the best prac- | 



SFILFB, CABL, M. JD., 

Lecturer on Laryngoscopy in the University of Pennsylvania. 

A Handbook of Diagnosis and Treatment of Diseases of the Throat, 
Nose and Naso-Pharynx. New (4th) edition. In one handsome royal 12mo. volume 

of about 400 pages, with 101 illustrations and 2 colored plates. Preparing. 
A notice of the previous edition is appended. 
Few medical writers surpass this author in of topics and methods. The book deserves a large 
ability to make his meaning perfectly clear in a sale, especially among general practitioners— Chi- 
few words, and in discriminat on in selection, both cago Medical Journal and Examiner, April, 1889. 



COHEN, J. SOLIS, M. JD., 

Lecturer on Laryngoscopy and Diseases of the Throat and Chest in the Jefferson Medical College. 

Diseases of the Throat and Nasal Passages. A Guide to the Diagnosis and 
Treatment of Affections of the Pharynx, (Esophagus, Trachea, Larynx and Nares. Third 
edition, thoroughly revised and rewritten, with a large number of new illustrations. In 
one very handsome octavo volume. Preparing. 



8CHAFEB, FBWABD A., F. B. S. 9 

Jodrell Professor of Physiology in University College, London. 

The Essentials of Histology. New (second) edition. In one octavo volume 
of 311 pages, with 325 illustrations. Cloth, $3.00. Just ready. 



KLEIN, E., M. I)., F. B. 8., 

Joint Lecturer on General Anat. and Phys. in the Med. School of St. Bartholomew's Hosp., London. 
Elements of Histology. Fourth edition. In one 12mo. volume of 376 pages, 
with 194 illus. Limp cloth, $1.75. See Students 7 Series of Manuals, page 30. 



FLINT'S PRACTICAL TREATISE ON THE 
PHYSICAL EXPLORATION OF THE CHEST 
AND THE DIAGNOSIS OF DISEASES AF- 
FECTING THE RESPIRATORS ORGANS. 
Second and revised edition. In one handsome 
octavo volume of 591 pages. Cloth, $4.50. 

BROWNE ON KOCH'S REMEDY IN RELATION 
TO THROAT CONSUMPTION. la one octavo 
volume of 121 pages, with 45 illustrations, 4 of 
which are colored, and 17 charts, Cloth, $1.50. 

GROSS' PRACTICAL TREATISE ON FOREIGN 



BODIES IN THE AIR-PASSAGES. In one 
octavo volume of 452 pages, with 59 illustrations. 
Cioth, $2.75. 

WOODHEAD'S PRACTICAL PATHOLOGY. A 
Manual for Students and Practitioners. In one 
beautiful octavo volume of 497 pages, with 136 
exquisitely colored illustrations. 

PEPPER'S SURGICAL PATHOLOGY. In one 
pocket-size 12mo. volume of 511 pages, with 81 
illustrations. Limp cloth, red edges, $2.00 See 
Students' Series of Manuals, page 31. 



18 Lea Brothers & Co.'s Publications — Pathology, Bacteriology. 



GIBBE8, HENEAGE, M. J)., 

Professor of Pathology in the University of Michigan, Medical Department. 

Practical Pathology and Morbid Histology. In one very handsome octavo 

volume of 314 pages, with 60 illustrations, mostly photographic. Cloth, $2.75. 



This is, in part, an expansion of the little work 
published by the author some years ago, and his 
acknowledged skill as a practical mieroseopist will 
give weight to his instructions. Indeed, m ful- 
ness of directions as to the modes of investigating 
morbid tissues the book leaves little to be desired. 



The work is throughout profusely illustrated with 
reproductions of micro-photographs. We may 
say that the practical histologist will gain much 
useful information from the book. — The London 
Lancet, January 23, 1892. 



ABBOTT, A. C, M. JD., 

First Assistant, Laboratory of Hygiene, University of Penna., Philadelphia. 
The Principles of Bacteriology : a Practical Manual for Students and Physi- 
cians. In one 12mo. volume of 259 pages with 32 illustrations. Cloth, $2. Just ready. 



During the last decade numerous works on this 
subject have been brought before the profession; 
yet, while many of them are exhaustive treatises, 
much of the laboratory technique requisite to the 
needs of beginners was omitted or most scantily 
treated. On reading this manual of Dr. Abbott, 
any one familiar with the subject will readily 
recognize the fact that the book is not merely a 
compilation from other works, but one giving 



evidence of the originality of the author, as well 
as complete knowledge of the practical details of 
bacteriology. His "scheme for the study of an 
organism" furnishes an excellent guide to the 
student. Of equal importance is the chapter on 
disinfectants, antiseptics and skin disinfection. 
It will form a valuable addition to the literature 
of laboratory technique and bacteriological inves- 
tigation.— The Therapeutic Gazette, May 16, 1892. 



SEJSTN, NICHOLAS, M.D., Ph.D., 

Professor of Surgery in Bush Medical College, Chicago. 
Surgical Bacteriology. New (second) edition. In one handsome octavo of 
268 pages, with 13 plates, of which 10 are colored, and 9 engravings. Cloth, $2. 

makes it possible for the busy practitioner, whose 



The book is really a systematic collection in the 
most concise form of such results as are published 
in current medical literature by the ablest workers 
in this field of surgical progress ; and to these are 
added the author's own views and the results of 
his clinical experience and original investigations. 
The book is valuable to the student, but its chief 
value lies in the fact that such a compilation 



time for reading is limited and whose sources of 
information are often few, to become conversant 
with the most modern and advanced ideas in sur- 
gical pathology, which have "laid the foundation 
for the wonderful achievements of modern sur- 
gery." — Annals of Surgery, March, 1892. 



GBEEN, T. HENRY, M. !>., 

Lecturer on Pathology and Morbid Anatomy at Charing-Cross Hospital Medical School, London. 

Pathology and Morbid Anatomy. Sixth American from the seventh revised 
English edition. Octavo, 539 pp., with 167 engravings. Cloth, $2.75. 

The Pathology and Morbid Anatomy of Dr. 
Green is too well known by members of the medi- 
cal profession to need any commendation. There 
is scarcely an intelligent physician anywhere who 
has not the work in his library, for it is almost an 
essential. In fact it is better adapted to the wants 
of general practitioners than any work of the kind 
with which we are acquainted. The works of 



German authors upon pathology, which have been 



translated into English, are too abstruse for the 
physician. Dr. Green's work precisely meets his 
wishes. The cuts exhibit the appearances of 
pathological structures just as they are seen 
through the microscope. The fact that it is so 
generally employed as a text-book by medical stu- 
dents is evidence that we have not spoken too 
much in its favor. — Cincinnati Medical News, Oct. 
1889. 



PAYNE, JOSEPH: F., M. H., F. B. C. P., 

Senior Assistant Physician and Lecturer on Pathological Anatomy, St. Thomas' Hospital, London. 
A Manual of General Pathology. Designed as an Introduction to the Prac- 
tice of Medicine. Octavo of 524 pages, with 152 illus. and a colored plate. Cloth, $3.50. 

cal factors in those diseases now with reasonable 



Knowing, as a teacher and examiner, the exact 
needs of medical students, the author has in the 
work before us prepared for their especial use 
what we do not hesitate to say is the best introduc- 
tion to general pathology that we have yet ex- 
amined. A departure which our author has 
taken is the greater attention paid to the causa- 
tion of disease, and more especially to the etiologi- 



certainty ascribed to pathogenetic microbes. In 
this department he has been very full and explicit, 
not only in a descriptive manner, but in the tech- 
nique of investigation. The Appendix, giving 
methods of research, is alone worth tne price of the 
book, several times over, to every student of 
pathology. — St. Louis Med. and Surg. Jour., Jan. '89. 



COATS, JOSEPH, M. JD., F. F. P. S., 

Pathologist to the Glasgow Western Infirmary. 
A Treatise on Pathology. In one very handsome octavo volume of 829 pages, 
with 339 beautiful illustrations. Cloth, $5.50 ; leather, $6.50. 



Medical students as well as physicians, who 
desire a work for study or reference, that treats 
the subjects in the various departments in a very 
thorough manner, but without prolixity, will cer- 
tainly give this one the preference to any with 
which we are acquainted. It sets forth the most 
recent discoveries, exhibits, in an interesting 



manner, the changes from a normal condition 
effected in structures by disease, and points out 
the characteristics of various morbid agencies, 
so that they can be easily recognized. But, not 
limited to morbid anatomy, it explains fully how 
the functions of organs are disturbed by abnormal 
conditions.— Cincinnati Medical News, Oct. 1883. 



Lea Brothers & Co.'s Publications — Nerv. and Ment. Dis., etc 19 
GRAY, LAJV&OJV CABTEB, M.JD., 

Professor of Diseases of the Mind and Nervous System in the New York Polyclinic. 

A Practical Treatise on Nervous and Mental Diseases. In one 8vo. 

volume of about 700 pages. Kichly illustrated. Shortly. 

This work is devoted purely to the practical aspects of nervous and mental diseases, 
especial care being taken to present the fundamental knowledge essential to a grasp of its 
subjects and to cast everything in the clearest possible form. The series of illustrations 
is rich and unique, embracing a large number of photographic engraviDgs of exceptional 
vividness and interest. By the employment of a style at once concise and clear, and by 
careful arrangement, the author is enabled to include an exposition of a vast and important 
subject in a condensed •and convenient form. 

BOSS, JAMES, M. D., F. B. C. F., LL. JD., 

Senior Assistant Physician to the Manchester Royal Infirmary. 

A Handbook on Diseases of the Nervous System. In one octavo 

volume of 725 pages, with 184 illustrations. Cloth, $4.50 ; leather, $5.50. 

The author has rendered a great service to the i disposal of the author, and of abridging the de- 
profession by condensing into one volume the scription of the different aspects of nervous dis- 
principal facts pertaining to neurology and nerv- eases, has been performed with singular skill, and 
ous diseases as understood at the present time, the result is a concise and philosophical guide to 
and he has succeeded in producing a work at once i the department of medicine of which it treats, 
brief and practical yet scientific, without entering j Dr. Ross holds such a high scientific position that 
into the discussion of theorists, or burdening the I any writings which bear his name are naturally 
mind with mooted questions. — Pacific Medical and I expected to have the impress of a powerful intel- 
Surgical Journal and Western Lancet, May, 1886. | lect. In every part this handbook merits the 



This admirable work is intended for students of 
medicine and for such medical men as have no time 
for lengthy treatises. In the present instance the 
duty of arranging the vast store of material at the 



highest praise, and will no doubt be found of the 
greatest value to the student as well as to the prac- 
titioner.— Edinburgh Medical Journal, Jan. 1887. 



HAMILTON, ALLAN McLAWE, M. JD., 

Attending Physician at the Hospital for Epileptics and Paralytics, BlackwelV s Island, N. Y. 

Nervous Diseases ; Their Description and Treatment. Second edition, thoroughly 

revised and rewritten. In one octavo volume of 598 pages, with 72 illustrations. Cloth, $4. 

When the first edition of this good book appeared characterized this book as the best of its kind in 

we gave it our emphatic endorsement, and the any language, which is a handsome endorsement 

E resent edition enhances our appreciation of the from an exalted source. The improvements in the 
ook and its author as a safe guide to students of new edition, and the additions to it, will justify its 
clinical neurology. One of the best and most purchase even by those who possess the old. — 
critical of English neurological journals, Brain, has Alienist and Neurologist, April, 1882. 

TUKE, DAJVIEL HACK, M. JD., 

Joint Author of The Manual of Psychological Medicine, etc. 

Illustrations of the Influence of the Mind upon the Body in Health 
and Disease. Designed to elucidate the Action of the Imagination. New edition. 
Thoroughly revised and rewritten. In one 8 vo. vol. of 467 pp., with 2 col. plates. Cloth, $3. 

method of interpretation. Guided by an enlight- 
ened deduction, the author has reclaimed for 
science a most interesting domain in psychology. 



It is impossible to peruse these interesting chap- 
ters without being convinced of the author's per- 
fect sincerity, impartiality, and thorough mental 
grasp. Dr. Tuke has exhibited the requisite 
amount of scientific address on all occasions, and 
the more intricate the phenomena the more firmly 
has he adhered to a physiological and rational 



previously abandoned to charlatans and empirics. 
This book, well conceived and well written, must 
commend itself to every thoughtful understand- 
ing. — New York Medical Journal, September 6, 1884. 



CLOUSTOJT, THOMAS S., M. JO., F. JR. C. F., L. B. €. S., 

Lecturer on Mental Diseases in the University of Edinburgh. 

Clinical Lectures on Mental Diseases. With an Appendix, containing an 
Abstract of the Statutes of the United States and of the Several States and Territories re- 
lating to the Custody of the Insane. By Charles F. Folsom, M. D., Assistant Professor 
of Mental Diseases, Med. Dep. of Harvard Univ. In one handsome octavo volume of 541 
pages, with eight lithographic plates, four of which are beautifully colored. Cloth, $4. 

j^°Dr. Folsom's Abstract may also be obtained separately in one octavo volume of 
108 pages. Cloth, $1.50. 

SAVAGE, GEORGE H., M. JD., 

Lecturer on Mental Diseases at Ghuy's Hospital, London. 
Insanity and Allied Neuroses, Practical and Clinical. In one 12mo. vol. 

of 551 pages, with 18 illus. Cloth, $2.00. See Series of Clinical Manuals, page 31. 

As a handbook, a guide to the practitioner and i carefully selected, and as regards treatment sound 
student, the book fulfils an admirable purpose, common sense is everywhere apparent. Dr. Sav- 
The many forms of insanity are described with age has written an excellent manual for the prac- 
characteristic clearness, the illustrative cases are i titioner and student. — Amer. Jour, of Insan., Apr.'85. 

FLATFAIB, W. S., M. I)., F. B. C. F. 

The Systematic Treatment of Nerve Prostration and Hysteria. In 

one handsome small 12mo. volume of 97 pages. Cloth, $1.00. 

BLANDFORD ON INSANITY AND ITS TREAT- JONES' CLINICAL OBSERVATIONS ON FUNC- 
MENT. Lectures on the Treatment, Medical | TIONAL NERVOUS DISORDERS. Second 
and Legal, of Insane Patients. In one very hand- American Edition. In one handsome octavo 
some octavo volume. volume of 340 pages. Cloth, $3.25 



20 



Lea Brothers & Co.'s Publications — Surgery, 



ROBERTS, JOHN B., M. JD. 9 

Professor of Anatomy and Surgery in the Philadelphia Polyclinic. Professor of the Principles and 
Practice of Surgery in the Woman'' s Medical College of Pennsylvania. Lecturer in Anatomy in the IJniver- 
sity of Pennsylvania. 

The Principles and Practice of Modern Surgery. For the use of Students 
and Practitioners of Medicine and Surgery. In one very handsome octavo volume of 780 
pages, with 501 illustrations. Cloth, $4.50; leather, $5.50. 



This work is a very comprehensive manual upon 
general surgery, and will doubtless meet with a 
favorable reception by the profession. It has a 
thoroughly practical character, the subjects are 
treated with rare judgment, its conclusions are in 
accord with those of the leading practitioners of 
the art, and its literature is fully up to all the ad- 



vanced doctrines and methods of practice of the 
present day. Its general arrangement follows 
this rule, and the author in his desire to be con- 
cise and practical is at times almost dogmatic, but 
this is entirely excusable considering the admira- 
ble manner in which he has thus increased the 
usefulness of his work.— Med. Rec, Jan. 17, 1891. 



ASHHTJRST, JOHN, Jr., M. D., 

Barton Prof, of Surgery and Clin. Surgery in Univ. of Penna., Surgeon to the Penna. Hosp., Phila. 

The Principles and Practice of Surgery. Fifth edition, enlarged and 
thoroughly revised. In one large and handsome octavo volume of 1144 pages, with 
642 illustrations. Cloth, $6 ; leather, $7. 



A complete and most excellent work on surgery. 
It is only necessary to examine it to see at once 
its excellence and real merit either as text-book 
for the student or a guide for the general practi- 
tioner. It fully considers in detail every surgical 
injury and disease to which the body is liable, and 



every advance in surgery worth noting is to be 
found in its proper place. It is unquestionably the 
best and most complete single volume on surgery,, 
in the English language, and cannot but receive 
that continued appreciation which its merits justly 
demand. — Southern Practitioner, Feb. 1890. 



DRUITT, ROBERT, M. R. C. S., etc. 

Manual of Modern Surgery. Twelfth edition, thoroughly revised by Stan- 
ley Boyd, M. B., B. S., F. R. C. S. In one 8vo. volume of 965 pages, with 373 illustra- 
tions. Cloth, $4 ; leather, $5. 



Druitt's Surgery has been an exceedingly popu- 
lar work in the profession. It is stated that 50,000 
copies have been sold in England, while in the 
United States, ever since its first issue, it has been 
used as a text-book to a very large extent. Dur- 
ing the late war in this country it was so highly 



appreciated that a copy was issued by the Govern- 
ment to each surgeon. The present edition, while 
it has the same features peculiar to the work at 
first, embodies all recent discoveries in surgery, 
and is fully up to the times.— Cincinnati Medical 
News, September, 1887. 



GANT, FREDERICK JAMES, E. R. C. S., 

Senior Surgeon to the Royal Free Hospital, London. 
The Student's Surgery. A 3fultum in Parvo. In one square octavo volume 
of 848 pages, with 159 engravings. Cloth, $3.75. 

GROSS, S. JD., M. JO., LL. J)., L>. C. L. Oxon., LL. D. 
Cantab., 

Emeritus Professor of Surgery in the Jefferson Medical College of Philadelphia. 
A System of Surgery : Pathological, Diagnostic, Therapeutic and Operative. 
Sixth edition, thoroughly revised and greatly improved. In two large and beautifully 
printed imperial octavo volumes containing 2382 pages, illustrated by 1623 engravings. 
Strongly bound in leather, raised bands, $15; very handsome half Bussia, $16. 

BALL, CHARLES B., M. Ch., JDub., F. R. C. S., E., 

Surgeon and Teacher at Sir P. Dun's Hospital, Dublin. 

Diseases of the Rectum and Anus. In one 12mo. volume of 417 pp., 
with 54 cuts, and 4 colored plates. Cloth, $2.25. See Series of Clinical Manuals 31. 

YOUNG, JAMES K., M. D., 

Instructor in Orthopaedic Surgery, University of Pennsylvania, Philadelphia. 

A Manual of Orthopaedic Surgery, Suitable for Students and Prac- 
titioners. In one 12mo. volume of about 400 pages, fully illustrated. Preparing. 

BUT LIN, HENRY T., F. R. C. S., 

Assistant Surgeon to St. Bartholomew's Hospital, London. 
Diseases of the Tongue. In one 12mo. volume of 456 pages, with S colored 
plates and 3 woodcuts. Cloth, $3.50. See Series of Clinical Manuals, page 31. 

GOULD, A. FEARCE, M. S., M. B., F. R. C. S„ 

Assistant Surgeon to Middlesex Hospital. 

Elements of Surgical Diagnosis. In one pocket-size 12mo. volume of 589 
Cloth, $2.00. See Students' Series of Manuals, page 30. 



PIRRIE'S PRINCIPLES AND PRACTICE OF 
SURGERY. Edited by John Neill, M. D. In 
one 8vo. vol. of 784 pp. with 316 illus. Cloth, $3.75. 

MILLER'S PRINCIPLES OF SURGERY. Fourth 
American from the third Edinburgh edition. In 



one 8vo. vol. of 638 pages, with 340 illustrations. 
Cloth, 83.75. 
MILLER'S PRACTICE OF SURGERY. Fourth 
and revised American edition. In one large 8vo. 
vol. of 682 pp., with 364 illustrations. Cloth J3.75. 



Lea Brothers & Co.'s Publications — Surgery. 



21 



EBICHSEN, JOHN E., F. B. Si, F. B. C. S., 

Professor of Surgery in University College, London, etc. 

The Science and Art of Surgery ; Being a Treatise on Surgical Injuries, Dis- 
eases and Operations. From the eighth and enlarged English edition. In two large 8vo. 
volumes of 2316 pages, with 984 engravings on wood. Cloth, $9; leather, $11. 



For many years this classic work has been 
made by preference of teachers the principal 
text-book on surgery for medical students, while 
through translations into the leading continental 
languages it may be said to guide the surgical 
teachings of the civilized world. No excellence 



of the former edition has been dropped and no 
discovery, device or improvement which has 
marked the progress of surgery during the last 
decade has been omitted. The illustrations are 
many and executed in the highest style of art. 
—Louisville Medical News, Feb. 14, 1885. 



BBYANT, THOMAS, F. B. C. S., 

Surgeon and Lecturer on Surgery at Guy's Hospital, London. 
The Practice Of Surgery. Fourth American from the fourth and revised Eng- 
lish edition. In one large and very handsome imperial octavo volume of 1040 pages, with 
727 illustrations. Cloth, $6.50; leather, $7.50. 

place the work among the highest order of text- 
books for the medical student. Almost every 
topic in surgery is presented in such a form as to 
enable the busy practitioner to review any subject 
in every-day practice in a short time. No time is 
lost with useless theories or superfluous verbiage. 
In short, the work is eminently clear, logical and 
practical -Chicago Med. Jour, and Examiner, Apr. '86. 



The fourth edition of this work is fully abreast 
of the times. The author handles his subjects 
with that degree of judgment and skill which is 
attained by years of patient toil and varied ex- 
perience. The present edition is a thorough re- 
vision of those which preceded it, with much new 
matter added. His diction is so graceful and 
logical, and his explanations are so lucid, as to 



WHABTON, HEN BY B., M. !>., 

Demonstrator of Surgery and Lecturer on Surgical Diseases of Children in the Univ. of Penna. 
Minor Surgery and Bandaging. In one very handsome 12mo. volume of 
498 pages, with 403 engravings, many being photographic. Cloth, $3.00. 



This new work must take a first rank as soon as 
examined. Bandaging is well described by words, 
and th9 methods are illustrated by photographic 
drawings, so as to make plain each step taken in 
the application of bandages of various kinds to dif- 
ferent parts of the body and extremities— including 
the head. The various operations are likewise de- 
scribed and illustrated, so that it would seem easy 
for the tyro to do the gravest amputation. The va- 



rious established operations are described in detail. 
Hence this work becomes a most valuable compan- 
ion-book to any of the more pretentious treatises 
on surgery, where simply the general advice is 
given to bandage, amputate, intubate, operate, etc. 
For the student and young surgeon, it is a very 
valuable instruction book from which to learn how 
to do what may be advised, in general terms, to be 
done. — Virginia Medical Monthly, October 1891. 



TBEVES, FBEDEBICK, F. B. C. S., 

Surgeon and Lecturer on Anatomy at the London Hospital. 

A Manual of Operative Surgery. In two octavo volumes containing 1550 
pages, with 422 original engravings. Complete work, cloth, $9; leather, $11. Just ready. 



Mr. Treves in this admirable manual of opera- 
tive surgery has in each instance practically 
assumed that operation has been decided upon 
and has then proceeded to give the various opera- 
tive methods which may be employed, with a 
criticism of their comparative value and a detailed 
and careful description of each particular stage 
of their performance. Especial attention has been 
paid to the preparatory treatment cf the patient 
and to the details of the after treatment of the 
case, and this is one of the most distinctive among 
the many excellent features of the book. We have 
no hesitation in declaring it the best work on the 
subject in the English language, and indeed, in 
many respects, the best in any language. It can- 



not fail to be of the greatest use both to practical 
surgeons and to those general practitioners who, 
owing to their isolation or to other circumstances, 
are forced to do much of their own operative work. 
We feel called upon to recommend the book so 
strongly for the excellent judgment displayed in 
the arduous task of selecting from among the 
thousands of varying procedures those most 
worthy of description ; for the way in which the 
still more difficult task of choosing among the 
best of those has been accomplished; and for the 
simple, clear, straightforward manner in which 
the information thus gathered from all surgical 
literature has been conveyed to the reader. — 
Annals of Surgery, March, 1892. 



By the Same Author. 
The Student's Handbook of Surgical Operations. In one square 12mo. 
volume of 508 pages, with 94 illustrations. Cloth, $2.50. Just ready. 

A Manual of Surgery. In Treatises by Various Authors, edited by Treves. 
In three 12mo. volumes, containing 1866 pages, with 213 engravings. Price per set, 
cloth, $6. See Students' Series of Manuals, page 30. 



We have here the opinions of thirty- three 
authors, in an encyclopedic form for easy and 
ready reference. The three volumes embrace 
every variety of surgical affections likely to be 
met with, the paragraphs are short and pithy, and 



the salient points and the beginnings of new sub- 
jects are always printed in extra-heavy type, so 
that a person may find whatever information he 
may be in need of at a moment's glance.— Cin- 
cinnati Lancet-Clinic, August 21, 1886. 



Intestinal Obstruction. In one pocket-size 12mo. volume of 522 pages, with 60 
illustrations. Limp cloth, blue edges, $2.00. See Series of Clinical Manuals, page 31. 

HOLMES, TIMOTHY, M. A., 

Surgeon and Lecturer on Surgery at St. George's Hospital, London. 

A System of Surgery ; Theoretical and Practical. IN TKEATISES BY 
VAEIOUS AUTHOKS. American edition, thoroughly revised and re-edited 
by John H. Packard, M. D., Surgeon to the Episcopal Hospital, Philadelphia, assisted 
by a corps of thirty-three of the most eminent American surgeons. In three large octavo 
volumes containing 3137 pages, with 979 illustrations on wood and 13 lithographic plates. 
Price per set, cloth, $18.00 ; leather, $21.00. Sold only by subscription. 



22 Lea Brothers & Co.'s Publications — Surgery , Frac, Disloc. 



SMITH, STEPHEN, M. D., 

Professor of Clinical Surgery in the University of the City of New York. 

The Principles and Practice of Operative Surgery. Second and 
thoroughly revised edition. In one very handsome octavo volume of 892 pages, with 
1005 illustrations. Cloth, $4.00; leather, $5.00. 

This excellent and very valuable book is one of 
the most satisfactory works on modern operative 
surgery yet published. Its author and publisher 
have spared no pains to make it as far as possible 



an ideal, and their efforts have given it a position 
prominent among the recent works in this depart- 
ment of surgery. The book is a compendium for 
the modern surgeon. The present edition is much 
enlarged, and the text has been thoroughly revised, 
so as to give the most improved methods in asep- 
tic surgery, and the latest instruments known for 



operative work. It cau be truly said that as a hand- 
book for the student, a companion for the surgeon, 
and even as a book of reference for the physician 
not especially engaged in the practice of surgery, 
this volume will long hold a most conspicuous 
place, and seldom will its readers, no matter how 
unusual the subject, consult its pages in vain. Its 
compact form, excellent print, numerous illustra- 
tions, and especially its decidedly practical char- 
acter, all combine to commend it.— Boston Medical 
and Surgical Journal, May 10, 1888. 



HOLMES, TIMOTHY, M. A., 

Surgeon and Lecturer on Surgery at St. George's Hospital, London. 

A Treatise on Surgery ; Its Principles and Practice. From the fifth 
English edition, edited by T. Pickering Pick, F. E. C. S. In one octavo volume of 997 
pages, with 428 illustrations. Cloth, $6.00 ; leather, $7.00. 



To the younger members of the profession and 
to others not acquainted with the book and its 
merits, we take pleasure in recommending it as a 
surgery complete, thorough, well-written, fully 
illustrated, modern, a work sufficiently volumi- 
nous for the surgeon specialist, adequately concise 



for the general practitioner, teaching those things 
that are necessary to be known for the successful 
prosecution of the physician's career, imparting 
nothing that in our present knowledge is consid- 
ered unsafe, unscientific or inexpedient.— Pacific 
Medical Journal, July, 1889. 



HAMILTON, FHANK H., M. Z>., LL. 2>., 

Surgeon to Bellevue Hospital, New York. 

A Practical Treatise on Fractures and Dislocations. New (8th) edi- 
tion, revised and edited by Stephen Smith, A. M., M. D., Professor of Clinical Surgery 



in the University of the City of New York, 
pages, with 507 illustrations. Cloth, $5.50 ; 
The work of Dr. Hamilton is so well known that 
a description is almost unnecessary. Its numer- 
ous editions are convincing proof if any is needed, 
of its value and popularity. It is pre eminently 
the authority on fractures and dislocations, and 
universally quoted as such. In the new edition it 
has lost none of its former worth. The additions 
it has received by its recent revision make it a 
work thoroughly in accordance with modern 
practice, theoretically, mechanically, aseptically. 
The task of writing a complete treatise on a sub- 



In one very handsome octavo volume of 832 
leather, $6.50. 

ject of such magnitude is no easy one. Dr. Smith 
has aimed to make the present volume a correct 
exponent of our knowledge of this department 
of surgery. In examining the volume one is at 
once struck with the evidence of the vast amount 
of labor its compilation and reconstruction must 
have necessitated. The more one reads the more 
one is impressed with its completeness. The work 
has been accomplished, and has been done clearly, 
concisely, excellently well.— Boston Medical and 
Surgical Journal, May 26, 1892. 



STIMSON, LEWIS A., B. A., M. 2>., 

Professor of Clinical Surgery in the Medical Faculty of Univ. of City of N. Y., 
A Manual of Operative Surgery. Second edition. In one very handsome 
royal 12mo. volume of 503 pages, with 342 illustrations. Cloth, $2.50. 

effected in operative methods and procedures by 
the antiseptic system, and has added an account 
of many new operations and variations in the 
steps of older operations. We do not desire to 
extol this manual above many excellent standard 
British publications of the same class, still we be- 
lieve that it contains much that is worthy of imi- 
tation. — British Medical Journal, Jan. 22, 1887. 



There is always room for a good book, so that 
while many works on operative surgery must be 
considered superfluous, that of Dr. Stimson has 
held its own. The author knows the difficult art 
of condensation. Thus the manual serves as a 
work of reference, and at the same time as a 
handy guide. It teaches what it professes, the 
steps of operations. In this edition Dr. Stimson 
has sought to indicate the changes that have been 



By the same Author. 
A Treatise on Fractures and Dislocations. In two handsome octavo vol- 
umes. Vol. I., Fractures, 582 pages, 360 beautiful illustrations. Vol. II., Disloca- 
tions, 540 pages, with 163 illustrations. Complete work, cloth, $5.50 ; leather, $7.50. 
Either volume separately, cloth, $3.00 ; leather, $4.00. 



The appearance of the second volume marks the 
completion of the author's original plan of prepar- 
ing a work which should present in the fullest 
manner all that is known on the cognate subjects 
of Fractures and Dislocations. The volume on 
Fractures assumed at once the position of authority 
on the subject, and its companion on Dislocations 
will no doubt be similarly received. The closing 
volume of Dr. Stimson's work exhibits the surgery 



of Dislocations as it is taught and practised by the 
most eminent surgeons of the present time. Con- 
taining the results of such extended researches it 
must for a long time be regarded as an authority 
on all subjects pertaining to dislocations. Every 

Eractitioner of surgery will feel it incumbent on 
im to have it for constant reference.— Cincinnati 
Medical News, May, 1888. 



with 93 



JPICK, T. PICKERING, E. H. C. S., 

Surgeon to and Lecturer on Surgery at St. George's Hospital, London. » 

Fractures and Dislocations. In one 12mo. volume of 530 pages, 
illustrations. Limp cloth, $2.00. See Series of Clinical Manuals, page 31. 

MAHSH, HOWARD, F. H. C. S., 

Senior Assistant Surgeon to and Lecturer on Anatomy at St. Bartholomew's Hospital, London. 
Diseases of the Joints. In one 12mo. volume of 468 pages, with 64 woodcuts 
and a colored plate. Cloth, $2.00. See Series of Clinical Manuals, page 31. 



Lea Brothers & Co.'s Publications — Otology, Ophthalmology. 23 



NORRIS, W3I. F., 31. !>., and OLIVER, CLEAS. A., M. 2>. 

Clin. Prof, of Ophthalmology in Univ. of Pa. 
A Text-Book of Ophthalmology. In one octavo volume of about 800 pages 
with illustrations. In press. 

BVRJSETT, CHARLES S., A. M., M. !>., 

Professor of Otology in the Philadelphia Polyclinic; President of the American Otological Society. 

The Ear, Its Anatomy ? Physiology and Diseases. A Practical Treatise 
for the use of Medical Students and Practitioners. Second edition. In one handsome 
octavo volume of 580 pages, with 107 illustrations. Cloth, $4.00 ; leather, $5.00. 

We note with pleasure the appearance of a second carried out, and much new matter added. Dr. 
edition of this valuable work. When it first came 



out it was accepted by the profession as one of 
the standard works on modern aural surgery in 
the English language; and in his second edition 
Dr. Burnett has fully maintained his reputation, 
for the book is replete with valuable information 
and suggestions. The revision has been carefully 



Burnett's work must be regarded as a very valua- 
ble contribution to aural surgery, not only on 
account of its comprehensiveness, but because it 
contains the results of the careful personal observa- 
tion and experience of this eminent aural surgeon. 
— London Lancet, Feb. 21, 1885. 



BERRY, GEORGE A., M. B., F. R. C. S., Ed., 

Ophthalmic Surgeon, Edinburgh Royal Infirmary. 
Diseases of the Eye. A Practical Treatise for Students of Ophthalmology. New 
(second) edition. In one octavo volume of about 700 pages, with about 150 illustrations, 
62 of which are beautifully colored. Preparing. 
A notice of the previous edition is appended. 

novice — with a mass of details with no key to their 



This newest candidate for favor among opbthal- 
mologioal students is designed to be purely clinical 
in character and the plan is well adhered to. We 
have been forcibly struck by the rare good taste 
in the selection of what is essential which per- 
vades the book. The author seems to have the 
uncommon faculty of viewing his subject as a 
whole and seizing the salient points and not con- 
fusing his reader — presumably a student and a 



unravelling. It is apparent that the literature ot 
each subject has been gone over in a very thor- 
ough manner. The fact that he was writing a 
clinical treatise for beginners and not an encyclo- 
paedia has always been present with the author. 
The number and excellence of the colored illus- 
trations in the text deserve more than a passing 
notice. — Archives of Ophthalmology, Sept. 1889. 



NETTLESSIP, EDWARD, F. R. C. S., 

Ophthalmic Surgeon at St. Thomas' Hospital, London. Surgeon to the Royal London (Moorfields) 
Ophthalmic Hospital. 

Diseases of the Eye. Fourth American from the fifth English edition, thor- 
oughly revised. With a Supplement on the Detection of Color Blindness, by Wil- 
liam Thomson, M. D., Professor of Ophthalmology in the Jefferson Medical College. 
In one 12mo. volume of 500 pages, with 164 illustrations, selections from Snellen's test- 
types and formulae, and a colored plate. Cloth, $2.00. 



This is a well-known and a valuable work. It 
was primarily intended for the use of students, 
and supplies their needs admirably, but it is as 
useful for the practitioner, or indeed more so. It 
does not presuppose the large amount of recondite 
knowledge to be present which seems to be as- 
sumed in some of our larger works, is not tedious 
from over-conciseness, and yet covers the more 



important parts of clinical ophthalmology. A 
supplement is made to the present edition on the 
practical examination of railroad employes as to 
color-blindness and acuteness of vision and hear- 
ing. This is well written, and contains good 
suggestions for those who may be called on to 
make such examinations. — ISew York Medical 
Journal, December 13, 1890. 



JJJLER, HENRY E., F. R. C. S., 

Senior Ass't Surgeon,Royal Westminster Ophthalmic Hosp.; late Clinical Ass't, Moor fields, London. 

A Handbook of Ophthalmic Science and Practice. English Edition. 
Handsome 870. volume of 442 pages, with 125 woodcuts, 27 colored plates, selec- 
tions from Test-types of Jaeger and Snellen, and Holmgren's Color-blindness Test. 
Cloth, $5.50 ; leather, $6.50. 



It presents to the student concise descriptions 
and typical illustrations of all important eye affec- 
tions, placed in juxtaposition, so as to be grasped 
at a glance. Beyond a doubt it is the best illus- 
trated handbook of ophthalmic science which has 
ever appeared. Then, what is still better, these 



illustrations are nearly all original. We have ex- 
amined this entire work with great care, and it 
represents the commonly accepted views of ad- 
vanced ophthalmologists. We can most heartily 
commend this book to all medical students, prac- 
titioners and specialists. — Detroit Lancet, Jan. '85. 



CARTER, R. BRJJDENELL, & FROST, W. ADAMS, 

F. R. C. S. f F. R. C. S., 

Ophthalmic Surgeon to and Led. on Ophthal- AssH Ophthalmic Surgeon and Joint Led. 

mic Surgery at St. George's Hospital, London. on Oph. Sur., St. George's Hosp., London. 

Ophthalmic Surgery. In one 12mo. volume of 559 pages, with 91 woodcuts, 
color-blindness test, test-types and dots and appendix of formulae. Cloth, $2.25. See 
Series of Clinical Manuals, page 31. 



WELLS ON THE EYE. In one octavo volume. 

LAURENCE AND MOON'S HANDY BOOK OF 
OPHTHALMIC SURGERY, for the use of Prac- 
titioners. Second edition. In one octavo vol- 
ume of 227 pages, with 65 illus. Cloth, $2.75. 



LAWSON ON INJURIES TO THE EYE, ORBIT 
AND EYELIDS: Their Immediate and Remote 
Effects. In one octavo volume of 404 pages, with 
92 illustrations. Cloth, $3.50. 



24 Lea Brothers & Co.'s Publications — Urin. Dis., Dentistry, etc. 



BOBEBTS, SIB WILLIAM, M. L>., 

Lecturer on Medicine in the Manchester School of Medicine, etc. 

A Practical Treatise on Urinary and Renal Diseases, including Uri- 
nary Deposits. Fourth American from the fourth London edition. In one hand- 
some octavo volume of 609 pages, with 81 illustrations. Cloth, $3.50. 



It may be said to be the best book in print on the 
subject of which it treats. — The American Journal 
of the Medical Sciences, Jan. 1886. 

The peculiar value and finish of the book are in 
a measure derived from its resolute maintenance 
of a clinical and practical character. It is an un- 
rivalled exposition of everything which relates 
directly or indirectly to the diagnosis, prognosis 
and treatment of urinary diseases, and possesses 



a completeness not found elsewhere in our lan- 
guage in its account of the different affections.— 
The Manchester Medical Chronicle, July, 1885. 

The value of this treatise as a guide book to the 
physician in daily practice can hardly be over- 
estimated. That it is fully up to the level of our 
present knowledge is a fact reflecting great credit 
upon Dr. Roberts, who has a wide reputation as a 
busy practitioner.— Medical Record, July 31, 1886. 



By the Same Author. 
Diet and Digestion. In one 12mo. volume of 270 pp. Cloth, $1.50. 



Just ready. 



I>UBI)Y, CJELABLES W., M. D., Chicago. 

Bright's Disease and Allied Affections of the Kidneys. In one octavo 

volume of 288 pages, with illustrations. Cloth, $2. 



The object of this work is to " furnish a system- 
atic, practical and concise description of the 
Sathology and treatment of the chief organic 
iseases of the kidney associated with albuminu- 
ria, which shall represent the most recent ad- 
vances in our knowledge on these subjects ; " and 
this definition of the object is a fair description of 
the book. The work is a useful one, giving in a 



short space the theories, facts and treatments, and 
going more fully into their later developments. 
On treatment the writer is particularly strong, 
steering clear of generalities, and seldom omit- 
ting, what text-books usually do, the unimportant 
items which are all important to the general prac- 
titioner.— The Manchester Medical Chronicle, Oct. 



MOBBIS, HENBY, M. B., F. B. C. 8., 

Surgeon to and Lecturer on Surgery at Middlesex Hospital, London. 

Surgical Diseases of the Kidney. In one 12mo. volume of 554 pages, with 40 
woodcuts, and 6 colored plates. Limp cloth, $2.25. See Series of Clinical Manuals, page 31. 



In this manual we have a distinct addition to 
surgical literature, which gives information not 
elsewhere to be met with in a single work. Such 
a book was distinctly required, and Mr. Morris 
has very diligently and ably performed the task 



he took in hand. It is a full and trustworthy 
book of reference, both for students and prac- 
titioners in search of guidance. The illustrations 
in the text and the chromo-lithographs are beau- 
tifully executed.— The London Lancet, Feb. 26, 1886. 



LUCAS, CLEMENT, M. B., B. 8., E. B. C. 8., 

Senior Assistant Surgeon to Guy's Hospital, London. 

Diseases of the Urethra. In one 12mo. volume. 
of Clinical Manuals, page 4. 



Preparing. See Series 



THOMPSON, SIB HENBY, 

Surgeon and Professor of Clinical Surgery to University College Hospital, London. 

Lectures on Diseases of the Urinary Organs. Second American from the 
third English edition. In one 8vo. volume of 203 pp., with 25 illustrations. Cloth, $2.25. 

By the Same Author. 
On the Pathology and Treatment of Stricture of the Urethra and 
Urinary Fistulse. From the third English edition. In one octavo volume of 359 
pages, with 47 cuts and 3 plates. Cloth, $3.50. 

THE AMEBIC AN SYSTEM OF JDENTISTBY. 

In Treatises by Various Authors. Edited by Wilbur F. Litch, M. D., 
D. D. S., Professor of Prosthetic Dentistry, Materia Medica and Therapeutics in the 
Pennsylvania College of Dental Surgery. In three very handsome octavo volumes con- 
taining 3160 pages, with 1863 illustrations and 9 full-page plates. Per volume, cloth, $6 ; 
leather, $7 ; half Morocco, gilt top, $8. The complete work is now ready. For sale by 
subscription only. 

doubtless it is), to mark an epoch in the history of 
dentistry. Dentists will be satisfied with it and 
proud of it— they must. It is sure to be precisely 
what the student needs to put him and keep him 
in the right track, while the profession at large 
will receive incalculable benefit from it.— Odonto- 
graphy Journal, Jan. 1887. 



As an encyclopaedia of Dentistry it has no su- 

f>erior. It should form a part of every dentist's 
ibrary, as the information it contains is of the 
greatest value to all engaged in the practice of 
dentistry. — American Jour. Dent. Sci., Sept. 1886. 

A grand system, big enough and good enough 
and handsome enough for a monument (which 



COLEMAN, A., L. B. C. JP., F. B. C. 8., Exam. L. I). 8., 

Senior Dent. Surg, and Led. on Dent. Surg, at St. Bartholomew' 1 s Hosp. and the Dent. Hosp., London. 

A Manual of Dental Surgery and Pathology. Thoroughly revised and 
adapted to the use of American Students, by Thomas C. Stellwagen, M. A., M. D., 
D. D. S., Prof, of Physiology in the Philadelphia Dental College. In one handsome octavo 
volume of 412 pages, with 331 illustrations. Cloth, $3.25. 

It should be in the possession of every practi- 
tioner in this country. The part devoted to first 
and second dentition and irregularities in the per- 
manent teeth is fully worth the price. In fact, 
price should not be considered in purchasing such 



a work. If the money put into some of our so- 
called standard text-books could be converted into 
such publications as this, much good would result. 
—Southern Dental Journal, May, 1882. 



BASHAM 
Guide to their Diagnosis and Treatment. In 



ON RENAL DISEASES : A Clinical I one 12mo. vol. of 304 pages, with 21 illustrations. 

| Cloth, 82.00. 



Lea Brothers & Co.'s Publications — Dis. of Men, Venereal, Skin. 25 



GBOSS, SAMUEL W., A. M., M. D., LL. D., 

Professor of the Principles of Surgery and of Clinical Surgery in the Jefferson Medical College of Phila. 

A Practical Treatise on Impotence, Sterility, and Allied Disorders 
of the Male Sexual Organs. Fourth edition, thoroughly revised by F. E. 
Stuegis, M. D., Prof, of Diseases of the Genito- Urinary Organs and of Venereal Diseases, 
N. Y. Post Grad. Med. School. In one very handsome octavo volume of 165 
with 18 illustrations. Cloth, $1.50. 



Three editions of Professor Gross' valuable book 
have been exhausted, and still the demand is 
unsupplied. Dr. Sturgis has revised and added 
to the previous editions, and the new one appears 
more complete and more valuable than before. 
Four important and generally misunderstood sub- 
jects are treated— impotence, sterility, spermator- 



rhoea, and prostatorrhcea. The book is a practical 
one and in addition to the scientific and very in- 
teresting discussions on etiology, symptoms, etc., 
there are lines of treatment laid down that any 
practitioner can follow and which have met with 
success in the hands of author and editor.— Medi- 
cal Record, Feb. 25, 1891. 



TAYLOR, B. W., A. M., M. JO., 

Clinical Professor of Genito-Urinary Diseases in the College of Physicians and Surgeons, New York, 
Prof, of Venereal and Skin Diseases in the University of Vermont. 

The Pathology and Treatment of Venereal Diseases. Including the 
results of recent investigations upon the subject. Being the sixth edition of Bumstead 
and Taylor. Entirely rewritten by Dr. Taylor. Large 8vo. volume, about 900 pages, 
with about 150 engravings, as well as numerous chromo-lithographs. In active preparation. 

A notice of the previous edition is appended. 
It is a splendid record of honest labor, wide upon the subjects of which it treats, but also one 
research, just comparison, careful scrutiny and which has no equal in other tongues for its clear, 
original experience, which will always be held as comprehensive and practical handling of its 
a high credit to American medical literature. This themes. — Am. Jour, of the Med. Sciences, Jan. 1884. 
is not only the best work in the English language 



CULVFB, F. M., M.D., and HAYDFN, J. B., M.I). 

Pathologist and Assistant Attending Surgeon, Chief of Clinic Venereal Department, Van- 

Manhattan Hospital, N. Y. derbilt Clinie, Col. of Phys. and Surgs , N. Y. 

A Manual of Venereal Diseases. In one 12mo. volume of 289 pages, with 
33 illustrations. Cloth, $1.75. 



This book is a practical treatise, presenting in a 
condensed form the essential features of our pres- 
ent knowledge of the three venereal diseases, 
syphilis, chancroid and gonorrhea. We have ex- 
amined this work carefully and have come to the 
conclusion that it is the most concise, direct and 
able treatise that has appeared on the subject of 
venereal diseases for the general practitioner to 



adopt as a guide. The general practitioner needs 
a few simple, concise and clearly presented laws, 
in the execution of which he cannot fail either to 
cure or prevent the ravages of the maladies in 
question and the direful results which their pro- 
pagation entails.— Buffalo Medical and Surgical 
Journal, May, 1892. 



(JOBNIL, V. 9 Prof, to the Faculty of Medicine of Paris, and Physician to the Lourcine Hosp. 

Syphilis, its Morbid Anatomy, Diagnosis and Treatment. Specially 
revised by the Author, and translated with notes and additions by J. Henry C. Simes, 



M. D., Demonstrator of Pathological Histology in the Univ. of Pa., and J. William 
White, M. D^ Lecturer on Venereal Diseases, Univ. of Pa. In one handsome octavo 
volume of 461 pages, with 84 very beautiful illustrations. Cloth, $3.75. 

perusal without the feeling that his grasp of the 
wide and important subject on which it treats is 
a stronger and surer one. — The London Practi- 



The anatomy, the histology, the pathology and 
the clinical features of syphilis are represented in 
this work in their best, most practical and most 
instructive form, and no one will rise from its 



tioner, Jan. 1882. 



sutchinson, Jonathan, f. b. s., f. b. c. s., 

Consulting Surgeon to the London Hospital. 
Syphilis. In one 12mo. volume of 542 pages, with 8 chromo-lithographs. 
$2.25. See Series of Clinical Manuals, page 31. 



Cloth, 



Those who have seen most of the disease and 
those who have felt the real difficulties of diagno- 
sis and treatment will most highly appreciate the 
facts and suggestions which abound in these 
pages. It is a worthy and valuable record, not 
only of Mr. Hutchinson's very large experience 



and power of observation, but of his patience and 
assiduity in taking notes of his cases and keep- 
ing them in a form available for such excellent 
use as he has put them to in this volume.— London 
Medical Record, Nov. 12, 1887. 



GBOSS, S. JO., M. L>., LL. JO., D. C. L., etc. 

A Practical Treatise on the Diseases, Injuries and Malformations 
of the Urinary Bladder, the Prostate Gland and the Urethra. Third 
edition, thoroughly revised by Samuel W. Gross, M. D. In one octavo volume of 574 
pages, with 170 illustrations. Cloth, $4.50. 

FYE-SMITH, P. H., M. D., F. B. S., 

Physician to Guy's Hospital, London. 

A Handbook of Diseases of the Skin. By Philip H. Pye-Smith, M. D t 
F. E. S , Physician to Guy's Hospital, London. In one octavo volume of 450 pages, 
with illustrations. Preparing. 



HILLIER'S HANDBOOK OF SKIN DISEASES; 
for Students and Practitioners. Second Ameri- 
can edition. In one 12mo. volume of 353 pages, 
with plates. Cloth, $2.25. 

HILL ON SYPHILIS AND LOCAL CONTAGIOUS 
DISORDERS. In one 8vo vol. of 479 p. Cloth, $3.25. 

LEE'S LECTURES ON SYPHILIS AND SOME 



WILSON'S STUDENT'S BOOK OF CUTANEOUS 
MEDICINE AND DISEASES OF THE SKIN. 
In one handsome small octavo volume of 535 
pages. < loth, $3.50. 
FORMS OF LOCAL DISEASE AFFECTING 
PRINCIPALLY THE ORGANS OF GENERA- 
TION. In one 8vo. vol. of 246 pages. Cloth, $2.25* 



26 



Lea Brothers & Co.'s Publications — Venereal, Skin, 



TAYLOR, ROBERT W„ A.M., M.D., 

Clinical Professor of Genito Urinarv Diseases in the College of Physicians and Surgeons, New Fork ; 
Surgeon to the Department of Venereal and Skin Diseases of the New Fork Hospital; Presi- 
dent of the American Dermatological Association. 

A Clinical Atlas of Venereal and Skin Diseases: Including Diagnosis, 
Prognosis and Treatment. In eight large folio parts, measuring 14 x 18 inches, and 
comprising 58 beautifully colored plates with 213 figures, and 431 pages of text with 85 
•engravings. Complete work just ready. Price per part, $2.50. Bound in one volume, 
half Eussia, $27 ; half Turkey Morocco, $28. For sale by subscription only. Specimen 
plates sent on receipt of 10 cents. A full prospectus sent to any address on application. 



It would be hard to use words which would per- 
spicuously enough convey to the reader the great 
value of this Clinical Atlas. This Atlas is more 
complete even than an ordinary course of clinical 
lectures, for in no one college or hospital course 
is it at all probable that all of the diseases herein 
represented would be seen. It is also more ser- 
viceable to the majority of students than attend- 
ance upon clinical lectures, for most of the 
students who sit on remote seats in the lecture 
hall cannot see the subject as well as the office 



student can examine these true- to-life chromo-lith- 
ographs. Comparing the text to a lecturer, it is 
more satisfactory in exactness and fulness than 
he would be likely to be in lecturing over a single 
case. Indeed, this Atlas is invaluable to the gen- 
eral practitioner, for it enables the eye of the 
physician to make diagnosis of a given case of 
skin manifestation by comparing the case with 
the picture in the Atlas, where will be found also 
the text of diagnosis, pathology, and full sections 
on treatment.— Virginia Medical Monthly, Dec. 1889. 



JACKSON, GEORGE THOMAS, M.I)., 

Professor of Dermatology, Woman's Medical College of the New York Infirmary. 

The Ready-Reference Handbook of Diseases of the Skin. In one 

12mo. volume of 544 pages, with 50 illustrations. Cloth, $2.75. Just ready. 

This volume is devoted to the art of dermatology, to the practice of this department of 
medicine in its latest development. No attempt has been made to discuss debatable ques- 
tions, and pathology and etiology do not receive as full consideration as symptomatology, 
diagnosis and treatment. The alphabetical arrangement of the different diseases has been 
adopted as conducive to the greatest possible convenience in use. The pages are illus- 
trated with a large number of engravings, many being photographic and vivid reproduc- 
tions of actual cases. A handsome lithographic frontispiece adds to the beauty and 
usefulness of a volume for which a wide recognition is assured. 



HARD AWAY, W. A., M. J). 



Professor of Skin Diseases in the Missouri Medical College, St. Louis. 
Manual of Skin Diseases. With Special Eeference to Diagnosis and Treat- 
ment. For the use of Students and General Practitioners. 12mo., 440 pp. Cloth, $3. 



Dr. Hardaway's large experience as a teacher 
and writer has admirably fitted him for the diffi- 
cult task of preparing a book which, while suffi- 
ciently elementary for the student is yet suffi- 
ciently thorough and comprehensive to serve as a 
book of reference for the general practitioner. It 



embraces all essential points connected with the 
diagnosis and treatment of diseases of the skin, 
and we have no hesitation in commending it as 
the best manual that has yet appeared in this 
department of Medicine.— Journal of Cutaneous 
and Genito- Urinary Diseases. 



HYDE, J. NEVINS, A. M., M. Z>., 

Professor of Dermatology and Venereal Diseases in Rush Medical College, Chicago. 

A Practical Treatise on Diseases of the Skin. For the use of Students and 
Practitioners. Second edition. In one handsome octavo volume of 676 pages, with 
2 colored plates and 85 beautiful and elaborate illustrations. Cloth, $4.50; leather, $5.50. 

His treatise is like his clinical instruction, 
admirably arranged, attractive in diction, and 
strikingly practical throughout. No clearer de- 
scription of the various primary and consecutive 



lesions of the skin is to be met with anywhere. 
Dr. Hyde has shown himself a comprehensive 
reader of the latest literature, and has incorpo- 
rated into his book all the best of that which 



the past years have brought forth. The prescrip- 
tions and formulae are given in both common and 
metric systems. Text and illustrations are good, 
and colored plates of rare cases lend additional 
attractions. Altogether it is a work exactly fitted 
to the needs of a general practitioner, and no one 
will make a mistake in purchasing it. — Medical 
of Western New York, June, 1888. 



JAMIESON, W. ALLAN, M. D. 9 

Lecturer on Diseases of the Skin, School of Medicine, Edinburgh. 
Diseases of the Skin. A Manual for Students and Practitioners. Third 
edition, revised and enlarged. In one octavo volume of 656 pages, with woodcut and 
nine double-page chromo- lithographic illustrations. Cloth, $6.00. Just ready. 

In common with other special departments in I This volume by Dr. Jamieson is a valuable one for 
medicine, that of dermatology is rapidly approach- | practitioners and students, as it is both full and 
ing an exactness in diagnosis and treatment which ! concise without being unwieldy and voluminous. — 
faiily places it at the front among the specialties. | The Jour, of the Amer. Med. Asso., March 19, 1892. 



FOX, T., M. H., F.R. C. P., and FOX, T. C, B.A., M.R. C.S., 

Physician to the Department for Skin Diseases, Physician for Diseases of the Skin to the 

University College Hospital, London. Westminster Hospital, London. 

An Epitome of Skin Diseases. With Formulae. For Students and Prac- 
titioners. Third edition, revised and enlarged. In one 12mo. vol. of 238 pp. Cloth, $1.25. 

for all one has to know is the name of the disease, 
and here are its description and the appropriate 



We cordially recommend Fox's Epitome to those 
whose time is limited and who wish a handy 
manual to lie upon the table for instant reference. 
Its alphabetical arrangement is suited to this use, 



treatment at hand, ready for instant application. 



Lea Brothers & Co.'s Publications — Dis. of Women. 



27 



The American Systems of Gynecology and Obstetrics. 

Systems of Gynecology and Obstetrics, in Treatises by American 
Authors. Gynecology edited by Matthew D. Mann, A. M., M. D., Professor of Obstetrics 
and Gynecology in the Medical Department of the University of Buffalo; and Obstet- 
rics edited by Barton Cooke Hirst, M. D., Associate Professor of Obstetrics in the 
University of Pennsylvania, Philadelphia. In four very handsome octavo volumes, con- 
taining 3612 pages, 1092 engravings and 8 plates. Complete work now ready. Per vol- 
ume: Cloth, $5.00; leather, $6.00; half Kussia, $7.00. For sale by subscription only* 
Address the Publishers. Full descriptive circular free on application. 

LIST OF CONTRIBUTORS. 



WILLIAM H. BAKER, M. D., 
ROBERT BATTEY, M. D., 
SAMUEL C. BUSEY, M. D., 
JAMES C. CAMERON, M. L\, 
HENRY C COE, A. M., M. D., 
EDWARD P. DAVIS, M. D., 
G. E. De SCHWEINITZ, M. D., 
E. C. DUDLEY, A. B., M. D., 
B. McE. EMMET, M. D., 
GEORGE J. ENGELMANN, M. D., 
HENRY J. GARRIGUES, A. M., M. D., 
WILLIAM GOODELL, A. M., M. D., 
EGBERT H. GRANDIN, A. M., M. D., 
SAMUEL W. GROSS, M. D., 
ROBERT P. HARRIS, M. D., 
GEORGE T. HARRISON, M. D., 
BARTON C. HIRST, M. D. 
STEPHEN Y. HOWELL, M. D., 
A. REEVES JACKSON, A. M., M. D., 
W. W. JAGGARD, M. D., 
EDWARD W. JENKS, M. D., LL. D., 
These volumes are the contributions of the most 
eminent gentlemen of this country in these de- 
partments of the profession. Each contributor pre- 
sents a monograph upon his special topic, so that 
everything in the way of history, theory, methods, 
and results is presented to our fullest need. As a 
work of general reference, it will be found remarka- 
bly full and instructive in every direction of 
inquiry.— -The Obstetric Gazette, September, 1889. 

One is at a loss to know what to say of this vol- 
ume, for fear that just and merited praise may be 
mistaken for flattery. The papers of Drs. Engel- 
mann, Martin, Hirst, Jaggard and Reeve are incom- 
parably beyond anything that can be found in 
obstetrical works.— Jo urnnlofthe American Medical 
Association, Sept. 8, 1888. 

In our notice of the "System of Practical Medi- 
cine by American Authors," we made the follow- 
ing statement :— " It is a work of which the pro- 
fession in this country can feel proud. Written 
exclusively by American physicians who are ac- 
quainted with all the varieties of climate in the 



D.. 



HOWARD A. KELLY, M. D., 
CHARLES CARROLL LEE, M. D., 
WILLIAM T. LUSK, M. D., LL. D., 
J. HENDRIE LLOYD, M. D., 
MATTHEW D. MANN, A. M., M. D., 
H. NEWELL MARTIN, F. R. S., M. 
RICHARD B. MAURY, M. D., 
C. D. PALMER, M. D., 
ROSWELL PARK, M. D., 
THEOPHILUS PARVIN, M. D., LL. D., 
R. A. F. PENROSE, M. D., LL. D., 
THADDEUS A. REAMY, A. M., M. D., 
J. C. REEVE, M. D., 
A. D. ROCKWELL, A. M., M. D., 
ALEXANDER J. C. SKENE, M. D., 
J. LEWIS SMITH, M. D., 
STEPHEN SMITH, M. D., 
R. STANSBURY SUTTON, M. D., LL.D., 
T. GAILLARD THOMAS, M. D., LL. D., 
ELY VAN DE WARKER, M. D., 
W. GILL WYLIE, M. D. 
United States, the character of the soil, the man- 
ners and customs of the people, etc., it is pecul- 
iarly adapted to the wants of American practition- 
ers of medicine, and it seems to us that every one 
of them would desire to have it." Every word 
thus expressed in regard to the "American Sys- 
tem of Practical Medicine" is applicable to the 
" System of Gynecology by American Authors." 
It, like the other, has been written exclusively 
by American physicians who are acquainted with 
all the characteristics of American people, who are 
well informed in regard to the peculiarities of 
American women, their manners, customs, modes 
of living, etc. As every practising physician is 
called upon to treat diseases of females, and as 
they constitute a class to which the family phy- 
sician must give attention, and cannot pass over 
to a specialist, we do not know of a work in any 
department of medicine that we should so strongly 
recommend medical men generally purchasing. — 
Cincinnati Med. News, July, 1887. 



EMMET, THOMAS ADDIS, M. D. 9 LL. D. 9 

Surgeon to the Woman's Hospital, New York, etc. 

The Principles and Practice of Gynaecology; For the use of Students and 
Practitioners of Medicine. Third edition, thoroughly revised. In one large and very 
handsome octavo volume of 880 pages, with 150 illustrations. Cloth, $5 ; leather, $6. 

the privilege thus offered them of perusing the 
views and practice of the author. His earnestness 
of purpose and conscientiousness are manifest. 
He gives not only his individual experience but 



We are in doubt whether to congratulate the 
author more than the profession upon the appear- 
ance of the third edition of this well-known work. 
Embodying, as it does, the life-long experience of 
one who has conspicuously distinguished himself 
as a bold and successful operator, and who has 
devoted so much attention to the specialty, we 
feel sure the profession will not fail to appreciate 



endeavors to represent the actual state of gynae- 
cological science and art. — British Medical Jour- 
nal, May 16, 1885. 



EDIS, AUTBUB W., M. D., Lond., F.R. C.P., M.K. C.S., 

Assist. Obstetric Physi cian to Middlesex Hospital, late Physician to British Lying-in Hospital. 
The Diseases of Women. Including their Pathology, Causation, Symptoms,, 
Diagnosis and Treatment. A Manual for Students and Practitioners. In one handsome 
octavo volume of 576 pages, with 148 illustrations. Cloth, $3.00 ; leather, $4.00. 

among the more common methods of treat- 



The special qualities which are conspicuous 
are thoroughness in covering the whole ground, 
clearness of description and conciseness of state- 
ment. Another marked feature of the book is 
the attention paid to the details of many minor 
surgical operations and procedures, as, for 
instance, the use of tents, application of leeches, 
and use of hot water injections. These are 



ment, and yet very little is said about them in 
many of the text-books. The book is one to be 
warmly recommended especially to students and 
general practitioners, who need a concise but com- 
plete resume of the whole subject. Specialists, too, 
will find many useful hints in its pages.— Boston 
Med. and Surg. Journ., March 2, 1882. 



HODGE ON DISEASES PECULIAR TO WOMEN. 
Including Displacements of the Uterus. Second 
edition, revised and enlarged. In one beauti- 
fully printed octavo volume of 519 pages, with 
original illustrations. Cloth, $4.50. 



WEST'S LECTURES ON THE DISEASES OP 
WOMEN Third American from the third Lon- 
don edition. In one octavo volume of 543 pages. 
Cloth, $3.75; leather, $4.75. , 



28 



Lea Brothers & Co.'s Publications — Diseases of Women. 



THOMAS, T. GAILLARI), and MUNDF, PAUL F., 

M. L>., LL. L>., M. L>., 

Emeritus Professor of Diseases of Women in the College Professor of Gynecology in the New York 

of Physicians and Surgeons, N. Y. Polyclinic. 

A Practical Treatise on the Diseases of Women. New (sixth) edition, 
thoroughly revised and rewritten by Dr. Munde. In one large and handsome octavo 
volume of 824 pages, with 347 illustrations, of which 201 are new. Cloth, $5 ; leather, $6. 



Probably no treatise ever written by an Ameri- 
can author on a medical topic has been accepted 
by more practitioners, a? a standard text-book, or 
read with pleasure and profit by more medical 
students than Thomas on the diseases of women. 
Next to the indescribable charm of listening to 
Dr. Thomas' lectures and clinics, which have in 
them the element of a captivating and inspiring 
personality— which must be heard and felt to be 
properly appreciated— is this volume, which in 
classic excellence, elegance of diction and scholar- 



ly and scientific statement must remain what it 
long has been, a standard text-book both for prac- 
titioner and student, at home and abroad, and an 
enduring pride to American gynecologists. In a 
field by no means new or wanting in honorabl3 
achievement, Dr. Munde has added to his already 
enviable reputation by the manner in which ha 
has acquitted himself in an undertaking at once 
so delicate and difficult and for which he will 
receive, at the hands of the profession, their ac- 
knowledgment. — The Brooklyn Med. Jour., Mar. '92. 



TAIT, LAW SON, F.M. C. S., 

Professor of Gynaecology in Queen's College, Birmingham ; late President of the British Gyne- 
cological Society ; Fellow American Gynecological Society. 

Diseases of "Women and Abdominal Surgery. In two octavo volumes. 
Volume I., 554 pages, 62 engravings and 3 plates. Cloth, $3. Volume II., preparing. 

Much of the text is abundantly illustrated with 



The plan of the work does not indicate the regu- 
lar system of a text book, and yet nearly every- 
thing of disease pertaining to the various organs 
receives a fair consideration. The description of 
diseased conditions is exceedingly clear, and the 
treatment, medical or surgical, is very satisfactory. 



cases, which add value in showing the results of 
the suggested plans of treatment. We feel con- 
fident that few gynecologists of the country will 
fail to place the work in their libraries. — The 
Obstetric Gazette, March, 1890. 



SUTTON, J. BLAND, F. B. C. S. 9 

Assistant Surgeon to the Middlesex Hospital, London. 

Surgical Diseases of the Ovaries and Fallopian Tubes, including 
Tubal Pregnancy. In one crown octavo volume of 544 pages with 119 engravings 
and 5 colored plates. Cloth, $3. Just ready. 



To gynecologists the name of Mr. Sutton has 
long been familiar as that of a conscientious 
worker in pelvic pathology, as well as a compara- 
tive anatomist of wide reputation. The present 
volume contains the substance of valuable papers 
which have been scattered throughout journals 
and society reports during the past five or six 
years, and deserves the careful attention of gen- 
eral readers as well as of specialists. Everything 



that the writer has to say is stated in a clear, 
practical way. The author's style is singularly 
concise — almost epigram matic. Statements which 
in a less weighty authority might appear too dog- 
matic gather force by the positive manner in 
which they are made. We have no hesitation in 
pronouncing it the best monograph of the kind 
which has yet appeared.— Medical Record, New 
York, May 21, 1892. 



DAVFNFOBT, F. S., M. D., 

Assistant in Gynaecology in the Medical Department of Harvard University, Boston. 

Diseases of Women, a Manual of Non-Surgical Gynecology. De- 
signed especially for the Use of Students and General Practitioners. New (second) 
edition. In one handsome 12mo. volume of 314 pages, with 107 illustrations. Cloth, 
$1.75. Just ready. 

The admirable tact of the author has given us a 
most excellent book. By omitting surgical gyn- 
ecology and conditions of rare occurrence, as well 
as discussions on rare and disputed points and 
pathological anatomy, much space has been saved. 
Much attention has been paid to the description 
and elucidation of seemingly minor but actually 
very important points which are not found in 
ordinary text-books. The pages devoted to meth- 
ods of examination are deserving of the highest 



commendation, as well as those devoted to a de- 
scription of instruments and general methods of 
treatment. While not over-elaborate, they are 
explicit and markedly practical. The whole 
work is in fact eminently practical, being devoted 
almost exclusively to symptomatology and treat- 
ment. It is upon the latter subject that the value 
of the book chiefly lies.— Gaillard's Medical Jour- 
nal, August, 1892. 



MAT, CSAMLFS S., M. D., 

Late House Surgeon to Mount Sinai Hospital, New York. 
A Manual of theDiseases of Women. Being a concise and systematic expo- 
sition of the theory and practice of gynecology. Second edition, edited by L. S. Kau, 
M. D., Attending Gynecologist at the Harlem Hospital, N. Y. In one 12mo. volume of 
360 pages, with 31 illustrations. Cloth, $1.75. 

This is a manual of gynecology in a very con- 
densed form, and the fact that a second edition 
has been called for indicates that it has met with 
a favorable reception. It is intended, the author 
tells us, to aid the student who after having care- 
fully perused larger works desires to review the 
subject, and he adds that it may be useful to the 
practitioner who wishes to refresh his memory 



rapidly but has not the time to consult larger 
works. We are much struck with the readiness 
and convenience with which one can refer to any 
subject contained in this volume. Carefully com- 
piled indexes and ample illustrations also enrich 
the work. This manual will be found to fulfil its 
purposes very satisfactorily. — The Physician and 
Surgeon, June, 1890. 



Lea Brothers & Co.'s Publications — Obstetrics, Dis. of Worn. 29 



PABVIN, THFOBHIZUS, M. !>., LL. D. 9 

Prof, of Obstetrics and the Diseases of Women and Children in Jefferson Med. Coll., Phila. 
The Science and Art of Obstetrics. Second edition, In one handsome 8vo. 
volume of 701 pages, with 239 engravings and a colored plate. Cloth, $ 1.25 ; leather, $5.25. 

obstetric literature can be found a work which is 
so comprehensive and yet compact and practical. 



The second edition of this work is fully up to the 
present state of advancement of the obstetric art. 
The author has succeeded exceedingly well in 
incorporating new matter without apparently in- 
creasing the size of his work or interfering with 
the smoothness and grace of its literary construc- 
tion. He is very felicitous in his descriptions of 
conditions, and proves himself in this respect a 
scholar and a master. Barely in the range of 



In such respect it is essentially a text book of the 
first merit. The treatment of the subjects gives a 
real value to the work— the individualities of a 
practical teacher, a skilful obstetrician, a close 
thinker and a ripe scholar. — Medical Record, Jan. 
17, 1891. 



BLAYFAIB, W. S., M. D. 9 F. B. C. P., 

Professor of Obstetric Medicine in King's College, London, etc. 

A Treatise on the Science and Practice of Midwifery. Fifth Amer- 
ican, from the seventh English edition. Edited, with additions, by Robert P. Harris, 
M. D. In one handsome octavo volume of 664 pages, with 207 engravings and 5 plates. 
Cloth, $4.00 ; leather, $5.00. 



Truly a wonderful book ; an epitome of all ob- 
stetrical knowledge, full, clear and concise. In 
thirteen years it has reached seven editions. It 
is perhaps the most popular work of its kind ever 
presented to the profession. Beginning with the 
anatomy and physiology of the organs concerned, 
nothing is left unwritten that the practical ac- 
coucheur should know. It seems that every 
conceivable physiological or pathological condi- 



tion from the moment of conception to the time 
of complete involution has had the author's 
patient attention. The plates and illustrations, 
carefully studied, will teach the science of mid- 
wifery. The reader of this book will have before 
him the very latest and best of obstetric practice, 
and also of all the coincident troubles connected 
therewith. — Southern Practitioner, Dec. 1889. 



In one 12mo. volume of 450 



KING, A. F. A., M. !>., 

Professor of Obstetrics and Diseases of Women in the Medical Department of the Columbian Univer- 
sity, Washington, D. C, and in the University of Vermont, etc. 

A Manual of Obstetrics. New (Fifth) edition, 
pages, with 150 illustrations. Cloth, $2 50. Just ready. 
A notice of the previous edition is appended. 

Dr. King, in the preface to the first eiition of 
this manual, modestly states that "its purpose is 
to furnish a good groundwork to the student at 



the beginning of his obstetric studies." Its pur- 
pose is attained; it will furnish a good ground- 
work to the student who carefully reads it; and 
further, the busy practitioner should not scorn the 
volume because written for students, as it con- 
tains much valuable obstetric knowledge, some 
of which is not found in more elaborate text- 
books. The chapters on the anatomy of the 
female generative organs, menstruation, fecunda- 



tion, the signs of pregnancy, and the diseases ot 
pregnancy, are all excellent and clear; but it is in 
the description of labor, both normal and abnor- 
mal, that Dr. King is at his best. Here his style 
is so concise, and the illustrations are so good, 
that the veriest tyro could not fail to receive a clear 
conception of labor, its complications and treat- 
ment. Of the 141 illustrations it may be safely 
said that they all illustrate, and that the engraver's 
work is excellent. From every standpoint we can 
most heartily recommend the book both to practi- 
tioner and student. — The Medical News, Dec. 7, 1889. 



BABJTFS, BOBFBT, 31. !>., and FAJTCOUBT, M. 2>., 

Phys. to the General Lying-in Hosp., Lond. Obstetric Phys. to St. Thomas' Hosp., Lond. 

A System of Obstetric Medicine and Surgery, Theoretical and Clin- 
ical. For the Student and the Practitioner. The Section on Embryology by Prof. Milnes 
Marshall. In one 8vo. volume of 872 pp., with 231 illustrations. Cloth, $5 ; leather, $6. 



The immediate purpose of the work is to furnish 
a handbook of obstetric medicine and surgery 
for the use of the student and practitioner. It is 
not an exaggeration to say of the book that it is 
the best treatise in the English language yet 
published, and this will not be a surprise to those 
who are acquainted with the work of the elder 
Barnes. Every practitioner who desires to have 



the best obstetrical opinions of the time in a 
readily accessible and condensed form, ought to 
own a copy of the book. — Journal of the American 
Medical Association, June 12, 1886. 

The Authors have made a text-book which is in 
every way quite worthy to take a place beside the 
best treatises of the period.— New York Medical 
Journal, July 2, 1887. 



nunrcAir, j. iiatthfws, m.n., ll. i>., f. b. s. e., etc. 

Clinical Lectures on the Diseases of Women ; Delivered in Saint Bar- 
tholomew's Hospital. In one handsome octavo volume of 175 pages. Cloth, $1.50. 

rule, adequately handled in the text-books ; others 



They are in every way worthy of their author ; 
indeed, we look upon them as among the most 
valuable of his contributions. They are all upon 
matters of great interest to the general practitioner. 
Some of them deal with subjects that are not, as a 



of them, while bearing upon topics that are usually 
treated of at length in such works, yet bear such a 
stamp of individuality that they deserve to be 
widely read.— N. Y. Medical Journal, March, 1880. 



WIirCKEL, F. 

A Complete Treatise on the Pathology and Treatment of Childbed. 

For Students and Practitioners. Translated, with the consent of the Author, from the 
second German edition, by J. K. Chadwick, M. D. Octavo 484 pages. Cloth, $4.00. 



30 



Lea Brothers & Co.'s Publications— Obstet., l>is. Cliildn. 



SMITH, J. LEWIS, M. D., 

Clinical Professor of Diseases of Children in the Bellevue Hospital Medical College, N. Y, 

A Treatise on the Diseases of Infancy and Childhood. New (seventh) 
edition, thoroughly revised and rewritten. In one handsome octavo volume of 881 
pages, with 51 illustrations. Cloth, $4.50 ; leather, $5.50. 



We have always considered Dr. Smith's book as 
one of the very best on the subject. It has always 
been practical— a field book, theoretical where 
theory has been deduced from practical experi- 
ence. He takes his theory from the bedside and 
the pathological laboratory. The very practical 
character of this book has always appealed to us. 
It is characteristic of Dr. Smith in all his writings 
to collect whatever recommendations are found in 
medical literature, and his search has been wide. 
One seldom fails to find here a practical suggestion 
after search in other works has been in vain. In 
the seventh edition we note a variety of changes 
in accordance with the progress of the times. It 
still stands foremost as the American text-book. 
The literary style could not be excelled, its advice 
is always conservative and thorough, and the 
evidence of research has long since placed its 



author in the front rank of medical teachers.— 
The American Journal of the Medical Sciences, Dec. 
1891. 

It has long been known as one of the ablest and 
most trustworthy books on the subject, and the 
latest edition is likely to add to its fame.— Edin- 
burgh Medical Journal, August, 1892 

In the present edition we notice that many of 
the chapters have been entirely rewritten. Full 
notice is taken of all the rece'nt advances that 
have been made. Many diseases not previously 
treated of have received special chapters. The 
work is a very practical ore. Especial care has 
been taken that the directions for treatment shall 
be particular and full. In no other work are such 
cartful instructions given in the details of infant 
hygiene and the artificial feeding of infants.— 
Montreal Medical Journal, Feb. 1891. 



LANDIS, JEEENMT G., A. M., M. D., 

Professor of Obstetrics and the Diseases of Women in Starling Medical College, Columbus, 0. 

The Management of Labor, and of the Lying-in Period. In one 

handsome 12mo. volume of 334 pages, with 28 illustrations. Cloth, $1.75. 

The author has designed to place in the hands as we can see, nothing is omitted. The advice is 
of the young practitioner a book in which he can sound, and the procedures are safe and practical. 
find necessary information in an instant. As far Centralblatt fur Oynakologie, December 4, 1886. 



MEBMAN, G. ERNEST, M. B., F. B. C. P., 

Obstetric Physician to the London Hospital. 

First Lines in Midwifery : a Guide to Attendance on Natural Labor 
for Medical Students and Midwives. In one 12mo. volume of 198 pages with 

80 illustrations. Cloth, $1.25. Just ready. See Student's Series of Manuals, below. 

This work is designed to give such elementary 
knowledge as may be needed by a midwife or 
student in the care of their first cases of normal 
labor, and it presents that knowledge in a clear 
and practical way. — The American Journal of Ob- 
stetrics, April, 1892. 

This is a little book, intended for the medical 



student and the educated midwife. The work 
is written in a plain, simple style, and is as 
much as possible devoid of technical terms. It 
will prove valuable to the beginner in midwifery 
and could be read with advantage by the majority 
of practitioners, old and young. — The Medical 
Fortnightly, April 15, 1892. 



OWEN, EDMUND, M. B., F. M. C. S., 

Surgeon to the Children's Hospital, Great Ormond St., London. 

Surgical Diseases of Children. In one 12mo. volume of 525 pages, with 4 
chromo-lithographic plates aud 85 woodcuts. Cloth, $2. See Series of Clinical Manuals, 
page 31. 



One is immediately struck on reading this book 
with its agreeable style and the evidence it every- 
where presents of the practical familiarity of its 
author with his subject. The book may be 



honestly recommended to both students and 
practitioners. It is full of sound information, 
pleasantly given. — Annals of Surgery, May, 1886. 



STUDENT'S SEBIES OF MANUALS. 

A Series of Fifteen Manuals, for the use of Students and Practitioners of Medicine and Surgery, 
written by eminent Teachers or Examiners, and issued in pocket-size 12mo volumes of 300-540 pages, 
richly illustrated and at a low price. The following volumes are now ready: Luff's Manual of Chem- 
istry, $2 ; Herman's First Lines in Midwifery, $1.25 ; Treves' Manual of Surgery, by various writers, in 
three volumes, per set, $6; each, $2; Bell's Comparative Anatomy and Physiology, $2; Gould's Surgical 
Diagnosis, $2; Robertson's Physiological Physics, $2; Brtjce's Materia Medica and Therapeutics (4th edi- 
tion), $1.50; Power's Human Physiology (2d edition), $1.50; Clarke and Lockwood's Dissectors' Man- 
ual, $1.50; Ralfe's Clinical Chemistry, $1.50; Treves' Surgical Applied Anatomy, $2; Pepper's Surgical 
Pathology, $2; and Klein's Elements of Histology (4th edition), $1.75. The following is in press: 
Pepper's Forensic Medicine. For separate notices see index on last page. 



CONDIE'S PRACTICAL TREATISE ON THE 
DISEASES OF CHILDREN. Sixth edition, re- 
vised and augmented. In one octavo volume of 
T79t>aees. Cloth. $5.25; leather. $6.25. 

LEISHMAN'S SYSTEM OF MIDWIFERY, IN- 
CLUDING THE DISEASES OF PREGNANCY 
AND THE PUERPERAL STATE. Fourth edi- 
tion. Octavo. 

WEST ON SOME DISORDERS OF THE NERV- 
OUS SYSTEM IN CHILDHOOD. In one small 
12mo. volume of 127 pages. Cloth, $1.00. 

PARRY ON EXTRA-UTERINE PREGNANCY' 
Its Clinical History, Diagnosis, Prognosis and 
Treatment. Octavo, 272 pages. Cloth, $2.50. 

CHURCHILL ON THE PUERPERAL FEVER 
AND OTHER DISEASES PECULIAR TO WO- 
MEN. In one 8vo. vol. of 464 pages. Cloth, $2.50, 

TANNER ON PREGNANCY. Octavo, 490 pages, 
colored plates, 16 cuts. Cloth, $4.25. 



ASHWELL'S PRACTICAL TREATISE ON THE 
DISEASES PECULIAR TO WOMEN. Third 
American from the third and revised London 
edition. In one 8vo. vol., pp. 520. Cloth, $3.50. 

MEIGS ON THE NATURE, SIGNS AND TREAT- 
MENT OF CHILDBED FEVER. In one 8vc. 
volume of 346 pages. Cloth. $2.00. 

RAMSBOTHAM'S PRINCIPLES AND PRAC- 
TICE OF OBSTETRIC MEDICINE AND 
SURGERY. In reference to the Process of 
Parturition. A new and enlarged edition, thor- 
oughly revised by the Author. With additions 
by W. V. Keating, M. D., Professor of Obstf tries, 
etc., in the Jefferson Medical College of Phila- 
delphia. In one large and handsome imperial 
octavo volume of 640 pages, with 64 full page 
plates and 43 woodcuts in the text, containing in 
all nearly 200 beautiful figures. Strongly bound 
in leather, with raised bands, $7. 



Lea Brothers & Co.'s Publications — Med. Juris., Miscel. 31 

SERIES OF CLINICAL MANUALS. 

In arranging for this Series it has been the design of the publishers to provide the profession with 
a collection of authoritative monographs on important clinical subjects in a cheap and portable form. 
The volumes contain about 550 pages and are freely illustrated by chromo-lithographs and wood- 
cuts. The following volumes are now ready: Yeo on Food in Health and Disease, $2; Beoadbent on 
the Pulse, $1.75; Caeter & Frost's Ophthalmic Surgery, $2.25; Hutchinson on Syphilis, $2.25; Ball on 
the Rectum and Anus, $2.25; Maesh on the Joints, $2; Owen on Surgical Diseases of Children, $2; 
Moeeis on Surgical Diseases of the Kidney, $2.25; Pick on Fractures and Dislocations, $2; Butlin on 
the Tongue, $3.50; Teeves on Intestinal Obstruction, $2; and Savage on Insanity and Allied Neuroses, $2. 
The following is in active preparation: Lucas on Diseases of the Urethra. For separate notices see 
index on last page. 

TAYLOR, ALFRED S., M. !>., 

Lecturer on Medical Jurisprudence and Chemistry in Ghiy's Hospital, London. 

A Manual of Medical Jurisprudence. New American from the twelfth 
English edition. Thoroughly revised by Claek Bell,, Esq., of the New York Bar. In 
one octavo volume of about 800 pages, with 56 illustrations. Just ready-. Cloth, $4.50; 
leather, $5.50. 

This work is the authority recognized not only by the medical profession but also by the 
Courts of all English-speaking countries. The present (9th) American edition, being based 
on the llth English edition, has had the benefit of successive revisions by the foremost 
medical experts, and finally by a legal authority who has made the subject an especial study 
from the standpoint of American practice. 

By the Same Author. 
Poisons in Relation to Medical Jurisprudence and Medicine. Third 
American, from the third and revised English edition. In one large octavo volume of 788 
pages. Cloth, $5.50 ; leather, $6.50. 

PEPPER, AUGUSTUS J., M. 8., M. B., F. R. C. S., 

Examiner in Forensic Medicine at the University of London. 
Forensic Medicine. In one pocket-size 12mo. volume. Preparing. See Students 7 
Series of Manuals, below. 

LEA 9 HENRY C., LL. Z>. 

The Formulary of the Papal Penitentiary. In one 8vo volume of 221 

pages with'a frontispiece. Shortly. 

By the same Author. 
Chapters from the Religious History of Spain.— In one 12mo. volume 

of 522 pages. Cloth, $2.50. 



The width, depth and thoroughness of research 
whifh have earned Dr. Lea a high European place 
as the ablest historian the Inquisition has yet 
found are here applied to some side-issues of that 
great subject. We have only to say of this volume 
that it worthily complements the author's earlier 
studies in ecclesiastical history. His extensive 
and minute learning, much of it from inedited 
manuscripts in Mexico, appears on every page.— 
London A ntiquary, Jan. 1891. 

After attentively reading the work one does not 
know whether the author is a Catholic, a Protestant 



or a free-thinker. This moderation deprives the 
indictment of none of its force. The facts and 
the documents, of which the number and novelty 
attest a patient erudition, are grouped in luminous 
order and produce on the reader an effect all the 
more powerful in that it seems the less designed. 
When we add that the style is in every way excel- 
lent, that it is clear, sober and precise, we do full 
justice to a work which reflects the highest honor 
on the talents of the writer and on the method of 
the modern school of history. — Revue Critique 
d'Histoire et de Literature, Paris, Jan. 1891. 



By the same Author. 
Superstition and Force : Essays on The Wager of Law, The Wager of 
Battle, The Ordeal and Torture. Bevised and enlarged edition. In one hand- 
some royal 12mo. volume of about 600 pages. New (fourth) edition. In press. 

By the Same Author. 
Studies in Church History. The Rise of the Temporal Power— Ben- 
efit of Clergy— Excommunication— The Early Church and Slavery. Sec- 
ond and revised edition. In one royal octavo volume of 605 pages. Cloth, $2.50. 

The author is preeminently a scholar; he takes 
up every topic allied with the leading theme and 
traces it out to the minutest detail with a wealth 
of knowledge and impartiality of treatment that 
compel admiration. The amount of information 
compressed into the book is extraordinary, and 
the profuse citation of authorities and references 
makes the work particularly valuable to the student 
who desires an exhaustife review from original 
sources. In no other single volume is the develop- 
ment of the primitive church traced with so much 
clearness and with so definite a perception of 



complex or conflicting forces.— Boston Traveller. 
It is some years since we read the first edition 
of this work by Mr. Lea, and the impression made 
by it on us at the time is confirmed by reperusal 
of it in this enlarged and improved form ; namely, 
that it is a book of great research and accuracy, 
full of varied information on very interesting 
phases of church life and history. It discusses 
each subject with a rare fulness of dates and in- 
stances, and a curious conscientiousness of veri- 
fication and citation of authorities.— Edinburgh 
Scotsman. 



By the Same Author. 
An Historical Sketch of Sacerdotal Celibacy in the Christian 
Church. Second edition, enlarged. In one octavo volume of 685 pages. Cloth, $4.50. 
This subject has recently been treated with very I more light on the moral condition of the Middle 
great learning and with admirable impartiality by Ages, and none which is more fitted to dispel the 
an American author, Mr. Henry C. Lea, in his His- \ gross illusions concerning that period which posi- 
tony of Sacerdotal Celibacy, which is certainly one j tive writers and writers of a certain ecclesiastical 
of the most valuable works that America has pro- | school have conspired to sustain.— Lecky's History 
duced. Since the great history of Dean Milman, of European Morals, Chap. V. 
I know no work in English which has thrown I 



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Abbott's Bacteriology * ... 18 

Allen's Anatomy ..... 6 

American Journal of the Medical Sciences . 2 
American Systems of Gynecology and Obstetrics 27 
American System of Practical Medicine . . 15 

American System of Dentistry 24 

A shhurst's Surgery . . . . .20 

Ashwell on Diseases of Women ... 29 
Attfleld's Chemistry . ... 9 

Ball on the Rectum and Anus . . .20, 31 

Barlow's Practice of Medicine ... 16 
Barnes' System of Obstetric Medicine . . 29 

Bartholow on Electricity .... 16 
Basham on Renal Diseases .... 24 
Bell's Comparative Anatomy and Physiology 7, 30 
Bellamy's Surgical Anatomy ... 6 

Berry on the Eye 23 

Billings' National Medical Dictionary . . 4 

Blandford on Insanity .... 19 

Bloxam's Chemistry . ... 9 

Bristowe's Practice of Medicine . . 13 

Broadbent on the Pulse . . . . 17, 31 

Browne on Koch's Remedy .... 17 
Browne on the Throat, Nose and Ear . . 17 

Bruce's Materia Medica and Therapeutics . 11, 30 
Brunton's Materia Medica and Therapeutics . 12 
Bryant's Practice of Surgery .... 21 
Bumstead and Taylor on Venereal. See Taylor. 25 
Burnett on the Ear . 23 

Butlin on the Tongue . . 20, 31 

Carpenter on the Use and Abuse of Alcohol . 7 
Carpenter's Human Physiology ... 7 
Carter & Frost's Ophthalmic Surgery . . 23, 31 

Chambers on Diet and Regimen ... 16 
Chapman's Human Physiology ... 8 
Charles' Physiological and Pathological Chem. 10 
Churchill on Puerperal Fever ... 30 
Clarke and Lockwood's Dissectors' Manual . 6, 30 
Classen's Quantitative Analysis ... 10 
Cleland's Dissector . .... 6 

Clouston on Insanity . ... 19 

Clowes' Practical Chemistry ... 8 

Coats' Pathology .... 18 

Cohen on the Throat .... 17 

Cohen's Applied Therapeutics . .13 

Coleman's Dental Surgery . .24 

Condie on Diseases of Children . . 30 

Cornil on Syphilis . . . . .25 

Cullerier & Bumstead on Venereal . . 25 

Culver & Hayden on Venereal Diseases . . 25 

Dalton on the Circulation .... 7 
Dalton's HumanPhysiologv ... 8 

Davenport on Diseases of Women . 28 

Davis' Clinical Lectures ... 16 

Draper's Medical Physics .... 7 
Druitt's Modern Surgery .... 20 
Duncan on Diseases of Women ... 29 
Dungllson's Medical Dictionary ... 5 
Edes' Materia Medica and Therapeutics . 11 

Edison Diseases of Women .... 27 
Ellis' Demonstrations of Anatomy . . 7 

Emmet's Gynaecology . 27 

Erichsen's System of Surgery ... 21 

Farquharson's Therapeutics and Mat. Med. . 12 
Finlayson's Clinical Diagnosis ... 15 

Flint on Auscultation and Percussion . . 17 

Flint on Phthisis 13 

Flint on Respiratory Organs ... 17 

Flint on the Heart . ... 13 

Flint's Essays . .... 13 

Flint's Practice of Medicine . . .13 

Folsom's Laws of TJ. S. on Custody of Insane . 19 
Foster's Physiology ..... 8 

Fotnergill's Handbook of Treatment . . 15 

Fownes' Elementary Chemistry ... 9 
Fox on Diseases of the Skin .... 26 

Frankland and Japp's Inorganic Chemistry . 9 
Fuller on the Lungs and Air Passages . . 16 

Gant's Student's Surgery .... 20 

Gibbes' Practical Pathology ... 18 

Gould's Surgical Diagnosis . . . . 20, 30 

Gray's Anatomy . . . . . .5 

Gray on Nervous and Mental Diseases . . 19 

Green's Pathology and Morbid Anatomy . 18 

Greene's Medical Chemistry .... 9 

Griffith's Universal Formulary ... 11 
Gross on Foreign Bodies in Air-Passages . 17 

Gross on Impotence and Sterility ... 25 
Gross on Urinary Organs . . 25 

Gross System of Surgery . . 20 

Habershon on the Abdomen . . 15 

Hamilton on Fractures and Dislocations . 22 

Hamilton on Nervous Diseases ... 19 
Hare's Practical Therapeutics . . .12 

Hare's System of Practical Therapeutics . 12 

Hardaway on the Skin . . . .26 

Hartshorne's Anatomy and Physiology . . 6 

Hartshorne's Conspectus of the Med. Sciences . 4 
Hartshorne's Essentials of Medicine . . 13 

Herman's First Lines in Midwifery . . 30 

Hermann's Experimental Pharmacology . 11 

Hill on Syphilis 25 

Hillier's Handbook of Skin Diseases . . 25 

Hirst & Piersol on Human Monstrosities . 6 

Hoblyn's Medical Dictionary . . . 4 

Hodge on Women .... 27 

Hoffmann and Power's Chemical Analysis . 10 
Holden's Landmarks ..... 5 
Holland's Medical Notes and Reflections . 16 

Holmes' Principles and Practice of Surgery . 22 
Holmes' System of Surgery ... 21 

Horner's Anatomy and Histology . . 6 

Hudson on Fever . ... 15 

Hutchinson on Syphilis . . .25,31 

Hyde on the Diseases of the Skin ... 26 
Jackson on the Skin . . .26 

Jamieson on the Skin . . . .26 

Jones (C. Handfield) on Nervous Disorders . 16 



Juler's Ophthalmic Science and Practice . 23 

King's Manual of Obstetrics . . . .29 

Klein's Histology . . .17,30 

Landis on Labor . ... 30 

La Roche on Pneumonia, Malaria, etc. . . 16 

La Roche on Yellow Fever .... 15 

Laurence and Moon's Ophthalmic Surgery . 23 

Lawson on the Eye, Orbit and Eyelid . . 23 

Lea's Chapters from Religious History of Spain 31 

Lea's Sacerdotal Celibacy . . . .31 

Lea's Studies in Church History ... 31 

Lea's Superstition and Force . .31 

Lee on Syphilis . . . . 

Lehmann^ Chemical Physiology . 

Leishman's Midwifery 

Lucas on Diseases of the Urethra . 

Ludlow's Manual of Examinations 

Luff's Manual of Chemistry 

Lyman's Practice of Medicine 

Lyons on Fe\ er . 

Maisch's Organic Materia Medica . 

Marsh on the Joints 

May on Diseases of Women . 

Medical News ..... 

Medical News Visiting List . 

Medical News Physicians' Ledger . 

Meigs on Childbed Fever 

Miller's Practice of Surgery . 

Miller's Principles of Surgery 

Morris on Diseases of the Kidney . 

Musser's Medical Diagnosis . 

National Dispensatory 

National Medical Dictionary 

Nettleship on Diseases of the Eye . . 

Norris and Oliver on the Eye 

Owen on Diseases of Children 

Parrish's Practical Pharmacy . . 

Parry on Extra-Uterine Pregnancy 

Parvin's Midwifery . ... 

Pavy on Digestion and its Disorders 

Payne's General Pathology . 

Pepper's System of Medicine 

Pepper's Forensic Medicine . 

Pepper's Surgical Pathology 

Pick on Fractures and Dislocations 

Pirrie's System of Surgery . 

Play fair on Nerve Prostration and Hysteria 

Playfair's Midwifery .... 

Power's Human Physiology . 

Purdy on Bright's Disease and Allied A flections 

Pye-Smith on the Skin 

Quiz Series .... 

Ralfe's Clinical Chemistry 

Ramsbotham on Parturition 

Remsen's Theoretical Chemistry . 

Reynolds' System of Medicine 

Richardson's Preventive Medicine 

Roberts on Diet and Digestion 

Roberts on Urinary Diseases 

Roberts' Compend of Anatomy . 

Roberts' Surgery . . . 

Robertson's Physiological Physics 

Ross on Nervous Diseases 

Savage on Insanity, including Hysteria . 

Schafer's Essentials of Histology, 

Schreiber on Massage . 

Seiler on the Throat, Nose and Naso-Pharynx 

Senn's Surgical Bacteriology 

Series of Clinical Manuals . . 

Simon's Manual of Chemistry 

Slade on Diphtheria .... 

Smith (Edward) on Consumption . 

Smith (J. Lewis) on Children 

Smith's Operative Surgery 

Stille on Cholera 

Still6 & Maisch's National Dispensatory 

Still6's Therapeutics and Materia Medica 

Stimson on Fractures and Dislocations 

Stimson's Operative Surgery 

Students' Quiz Series .... 

Students' Series of Manuals . 

Sturges' Clinical Medicine . 

Sutton on the Ovaries and Fallopian Tubes 

Tait's Diseases of Women and Abdom. Surgery 

Tanner on Signs and Diseases of Pregnancy 

Tanner's Manual of Clinical Medicine . 

Taylor's Atlas of Venereal and Skin Diseases 

Taylor on Venereal Diseases 

Taylor on Poisons .... 

Taylor's Medical Jurisprudence 

Thomas & Munde on Diseases of Women . 28 

Thompson on Stricture .... 24 

Thompson on Urinary Organs . . .24 

Todd on Acute Diseases 

Treves' Manual of Surgery . 

Treves' Operative Surgery . 

Treves' Student's Handbook of Surg. Operations, 21 

Treves' Surgical Applied Anatomy . .6,30 

Treves on Intestinal Obstruction . . .21,31 

Tuke on the Influence of Mind on the Body . 19 

Vaughan & Novy's Ptomaines and Leucomaines 10 

Visiting List, The Medical News . . 3 

Walshe on the Heart 16 

Watson's Practice of Physic .... 13 

Wells on the Eye .... 23 

Weston Diseases of Women • • • „I 

West on Nervous Disorders in Childhood . 30 

Wharton's Minor Surgery and Bandaging . 21 

Whitla's Dictionary of Treatment . . 15 

Williams on Consumption . . . • !?. 

Wilson's Handbook of Cutaneous Medicine . 25 

Wilson's Human Anatomy 6 

Winckel on Pathol, and Treatment of Childbed 29 

Wohler's Organic Chemistry 7 

Woodhead's Practical Pathology . If 

Year-Books of Treatment for 86, '87, '90, 'SI, '92. ]6 

Yeo on Food in Health and Disease . .16,30 

Young's Orthopaedic Surgery ... 20 



24,30 

4 

9,30 

15 

15 

11 

22,31 

28 

1 

3 

3 

30 

20 

20 

24,31 

15 

11 

4 



30,31 

10 

29 

29 

16 

18 

14 

30,31 

17,30 

22,31 

20 

19 

29 

7.30 

24 

25 

2 

10,30 

30 

10 

13 

16 

24 

24 

7 

20 
7,30 
19 
19,31 
17 
16 
17 
18 



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